Efficacy of Intragastric Balloon Placement and Botulinum Toxin Injection in Bariatric Endoscopy

A New and Effective Technique in the Endoscopic Treatment of Obesity and Regulation of Diabetes: The Pyloric Revision

AIM

This study aimed to investigate the role of the functional structure of the pylorus in obesity and diabetes and to determine the efficacy of a new method, pyloric revision (PR), in the treatment.

METHODS

The pyloric structures of the patients who applied for endoscopic obesity treatment were examined, and the patients were classified as normotonic (NP), hypotonic (HP), and atonic (AP) according to their pyloric structures. PR was applied to those with pyloric structural disorders. Patients with NP were also given the preferred endoscopic treatment (balloon, botulinum toxin, Kanlioz technique). In addition, the pre-procedure fasting blood glucose (FBG) and glycated hemoglobin levels (HbA1c) of the patients were compared with the sixth-month post-procedure status. In order to compare the pyloric structure and other parameters in normal weights with the obese group, a second group of 100 normal-weight (BMI<25) individuals was formed and compared with the study group.

RESULTS

In patients with HP (93 patients) and AP (61 patients), a statistically significant decrease was found between HbA1c and FBG levels before treatment and six months after treatment (p˂0.02, p<0.001, respectively). There was a statistically significant difference in favor of the endoscopic obesity treatment group (EOTG) in terms of pyloric disorder, HbA1c, and FPG levels between the EOTG and the normal weight group (NWG) (p<0.0001).

CONCLUSION

We recommend using PR as an easy-to-perform, effective, minimally invasive, reproducible, and cost-effective technique that does not require hospitalization.

Comparison of The Short-Term Effects of Intragastric Balloon and Botulinum Toxin Injection On Weight Loss

Aim: To compare the effects of endoscopic intragastric balloon (IGB) placement and intragastric botulinum toxin-A (BTX-A) injection in terms of weight loss among patients with non-morbid obesity. Methods: This retrospective single center study was conducted between 01.08.2020 and 01.01.2022. A total of 39 patients with a body mass index (BMI) of &lt;40 without comorbidities were included in the study. Nineteen underwent intragastric BTX-A injection and 20 underwent IGB placement. Patients were evaluated 1 month and 6 months after the procedures. Results: Mean age was 39.4 ± 8.6 in the BTX-A group and 37.3 ± 10.4 in the IGB group (p = 0.496). 78.9% of the BTX-A group and 75.0% of the IGB group were female (p = 1.000). In both groups, the median weight 1 month after the procedure was significantly lower than before the procedure, and the median weight 6 months after the procedure was significantly lower than 1 month after the procedure (p&lt;0.001 for both groups). The median weight loss in the IGB group at both the 1st and 6th months was significantly greater than the corresponding values of the BTX-A group (p &lt; 0.001 for both). Conclusion: IGB insertion appears to be a more successful endoscopic bariatric procedure than intragastric BTX-A injection, as measured by weight loss at post-intervention 1 month and 6 months. IGB may be preferred in patients with a BMI below 40 without obesity-related comorbidity.

Impact of Vagotomy on Postoperative Weight Loss, Alimentary Intake, and Enterohormone Secretion After Bariatric Surgery in Experimental Translational Models

Obesity may be treated by bariatric procedures and is related to enterohormone release modulation. Nevertheless, a majority of commonly used surgical procedures have a significant impact on vagus nerve function by breaking the connections with its gastric branches. In the case of an intragastric balloon (BAL), this interaction is unclear. However, BAL-induced weight reduction is not long-lasting. Interestingly, this method has not been used in combination with vagotomy (VAG). Thus, we evaluated, for the first time, the short- and long-term effects of combined BAL and VAG using the animal-based translational model and compared these effects with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Wistar rats were fed a high-calorie diet for 8 weeks to induce obesity before SG, RYGB, BAL + / - VAG. Animals' weight and eating behaviors were monitored weekly. After 90 days, serum samples were collected to evaluate postprandial and fasting GLP-1, GIP, PYY, ghrelin, glucagon, insulin, leptin, and pancreatic polypeptide concentrations by fluorescent assay. VAG, SG, RYGB, and BAL + VAG significantly reduced body weight 30 and 90 days after surgery. BAL alone induced temporal weight reduction observed after 30 days, reversed after 90 days. Calories intake was reduced at the first half of the observation period in all groups. Fluid intake was reduced in all groups except SG and BAL. Enterohormone profile for BAL + VAG was comparable to SG and RYGB but not BAL. VAG and BAL + VAG but not BAL alone maintain weight reduction, alimentary intake changes, and enterohormone release after long-term observation. VAG may improve the effectiveness of bariatric procedures for obesity treatment in clinical practice.