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Karcioglu O, Akman C, Atnis I. Efficacy and Safety Analysis of Botox Application and Iatrogenic Botulism: Panacea or Peril? Curr Pharm Des 2024; 30:578-588. [PMID: 38409723 DOI: 10.2174/0113816128284720240212111926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/24/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024]
Abstract
Clostridium botulinum toxin-A (BoNT-A) creates temporary paralysis in the muscles by acting on the muscle-nerve junction. It is injected into the mimic muscles when a decrease in the movements of the mimic muscles is desired. Despite many favorable applications, the use of BoNT-A is not without drawbacks. Although there is no expected serious side effect on health in BoNT-A treatments, various problems can be encountered in patients treated for aesthetic purposes. Botulism is a rare but potentially life-threatening syndrome, which is caused by the toxin produced by the bacterium Clostridium botulinum, which acts on the nervous system, vegetative forms of C. botulinum can only survive in anaerobic conditions, while spore forms are common in nature and can withstand harsh conditions. Botulism can stem from bacterial spores which release toxin in the body; in the form of enteric botulism, and wound botulism. The cases that develop 'iatrogenic botulism' after such procedures are usually those receiving high-dose toxin for therapeutic purposes. The treatment of botulism mainly consists of anti-toxin therapy and, if necessary, intensive care to prevent organ failures, including respiratory support. This article aims to cover all these issues related to botulism and other adverse outcomes related to BoNT-A injection in light of the most recent literature.
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Affiliation(s)
- Ozgur Karcioglu
- Department of Emergency Medicine, Taksim Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Canan Akman
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ilknur Atnis
- Department of Emergency Medicine, Niğde Omer Halisdemir Education and Research Hospital, University of Health Sciences, Nigde, Turkey
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Hennen C, Demir S, Dafsari HS, Wunderlich G, Böll B, Hüser C, Barbe MT, Fink GR, Rueger MA. Botulism after intragastric botulinum toxin injections for weight reduction. Eur J Neurol 2023; 30:3979-3981. [PMID: 37584071 DOI: 10.1111/ene.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023]
Abstract
Although-considering the risk-benefit ratio-botulinum neurotoxin A (BoNT/A) is unequivocally recommended to treat severe neurological diseases such as dystonia, this has not yet been determined for its endoscopic intragastric injection aimed at weight reduction in obesity. However, severe adverse effects of intragastric BoNT/A had not yet been reported, prompting some European countries to endorse its (off-label) use and treat patients transnationally. We here present three cases of botulism after intragastric BoNT/A injections for obesity treatment in a Turkish hospital. Patients presented with cranial nerve affection, bulbar symptoms, and descending paresis, and benefited from treatment with BoNT antitoxin and pyridostigmine. We assume that iatrogenic botulism was induced by overdosing in combination with toxin spread via the highly vascularized gastric tissue. Of note, within a few weeks, more than 80 cases of iatrogenic botulism were reported across Europe after identical intragastric BoNT/A injections. These cases demonstrate the risks of BoNT/A injections if they are not applied within the limits of evidence-based medicine. There is a need for international guidelines to define the indication and a safe dosing scheme, especially in the context of medical tourism.
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Affiliation(s)
- Christina Hennen
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Seda Demir
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Haidar Salimi Dafsari
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Boris Böll
- First Department of Internal Medicine; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Hüser
- Department of Internal Medicine II, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Thomas Barbe
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Jülich, Germany
| | - Maria Adele Rueger
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Jülich, Germany
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Kanlioz M, Ekici U. A New and Effective Technique in the Endoscopic Treatment of Obesity and Regulation of Diabetes: The Pyloric Revision. Cureus 2023; 15:e43357. [PMID: 37701000 PMCID: PMC10493824 DOI: 10.7759/cureus.43357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
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.
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Affiliation(s)
- Murat Kanlioz
- General Surgery, Flora Transplantation Institute, Istanbul, TUR
| | - Ugur Ekici
- General Surgery, Flora Transplantation Institute, İstanbul, TUR
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Jain N. Outbreaks of iatrogenic botulism in Europe: Combating off-label medical use of Botulinum Neurotoxin (BoNT) in bariatric procedures. New Microbes New Infect 2023; 53:101152. [PMID: 37441153 PMCID: PMC10333734 DOI: 10.1016/j.nmni.2023.101152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/15/2023] Open
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Theodoridis X, Chourdakis M, Haidich AB, Stamouli EM, Pagkalidou E, Fotiadou I, Talimtzi P, Gkaliagkousi E, Triantafyllou A. Treatment of obesity with intragastric injection of botulinum toxin. Is it worth the pinch? An overview of systematic reviews and meta-analysis. Obes Res Clin Pract 2023:S1871-403X(23)00048-0. [PMID: 37230812 DOI: 10.1016/j.orcp.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND AIMS Αvaialble evidence regarding the effectiveness of intragastric injection of botulinum toxin in reducing anthropometric indices of subjects with obesity is conflicting. We evaluated the existing evidence and perform a meta-analysis to assess the efficacy of intragastric botulinum toxin in treating obesity. METHODS We identified published systematic reviews evaluating the efficacy of intragastric injection of botulinum toxin in patients with overweight or obesity and additionally performed a systematic literature search to retrieve randomized controlled trials on this topic. A random-effects meta-analysis was performed to synthesize the existing studies. RESULTS A total of four systematic reviews were included in our overview of systematic reviews and six randomized controlled trials were included in our meta-analysis. Compared to placebo, intragastric injection of botulinum toxin was ineffective in reducing body weight and body mass index after the application of the Knapp-Hartung adjustment (MD = -2.41 kg, 95%CI = -5.21 to 0.38, I2 =59% and MD = -1.43 kg/m2, 95%CI = -3.04 to 0.18, I2 =62%, respectively). Moreover, treatment with intragastric injection with botulinum toxin was not superior to placebo in decreasing waist and hip circumference. CONCLUSIONS Based on the available evidence, intragastric injection with botulinum toxin is an ineffective procedure in reducing body weight and body mass index when the Knapp-Hartung method was applied.
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Affiliation(s)
- Xenophon Theodoridis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3rd Clinic of Internal Medicine, Papageorgiou Hospital, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Anna-Bettina Haidich
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni-Maria Stamouli
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Eirini Pagkalidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iliana Fotiadou
- Faculty of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | - Persefoni Talimtzi
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evgenia Gkaliagkousi
- 3rd Clinic of Internal Medicine, Papageorgiou Hospital, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Clinic of Internal Medicine, Papageorgiou Hospital, School of Medicine, Faculty of Health Sciences Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bariatric surgery trends and progress in Taiwan: 2010-2021. Obes Res Clin Pract 2023; 17:66-73. [PMID: 36623996 DOI: 10.1016/j.orcp.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/04/2022] [Accepted: 12/18/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Taiwan is a leading country regarding bariatric surgery in Asia-Pacific. Since 2010, the Taiwan Society for Metabolic and Bariatric Surgery (TSMBS) has been accountable for the national evolution of bariatric surgery and inaugurated a national database accordingly. This study aimed to analyze the bariatric surgery trends and progress in Taiwan from 2010 to 2021. MATERIALS AND METHODS The TSMBS database was collected on the basis of structured inquiries filled out by bariatric surgeons in Taiwan. All patients involving bariatric surgery were included. The data were stratified with the following objectives, including the types of bariatric procedures, demographic characteristics, and perioperative variables. A nationwide database was comprehensively analyzed and evaluated to determine the trends in the applications of the procedure. RESULTS Data of 30,026 patients were enrolled. A 2.5-fold increase was observed in bariatric procedures, from 1218 in 2010 to 3005 in 2021. Within 12 years, female accounts for 61.8 %. The revisional rate was 3.40 % during the exploration stage (2010-2013), 2.77 % during the maturity stage (2013-2018), and 5.10 % during the expansion stage (2019-2021). The top five of primary bariatric surgery is sleeve gastrectomy (SG, 63.05 %), gastric clipping surgery (GC, 11.17 %), Roux-en-Y gastric bypass (RYGB, 9.34 %), one anastomosis gastric bypass (OAGB, 8.80 %), and sleeve plus surgery (SG plus, 4.43 %). CONCLUSION The trends and progress of Taiwan's bariatric surgery within recent decades are presented in this article. Taiwan's bariatric surgery case number has increased steadily from 2010 to 2021. Amongst all, SG has become the most dominant procedure since 2011 while OAGB takes up second place in 2020.
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AlLehibi AH, Al-Haddad M. Intragastric botulinum toxin injection: Is it the solution to all gastric ailments? Saudi J Gastroenterol 2022; 28:247-249. [PMID: 35848699 PMCID: PMC9408734 DOI: 10.4103/sjg.sjg_261_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Abed H AlLehibi
- Department of Gastroenterology & Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
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Hsu PK, Wu CL, Yang YH, Wei JCC. Effect of Intragastric Botulinum Type A Injection Combined with a Low-Calorie High-Protein Diet in Adults with Overweight or Obesity. J Clin Med 2022; 11:3325. [PMID: 35743396 PMCID: PMC9225463 DOI: 10.3390/jcm11123325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background/aims: Intragastric botulinum toxin A injection (IGBI) combined with diet control is a new and effective weight loss method for grade 2 obese patients. However, the application of IGIB on overweight or obese adults still needs further research to confirm its efficacy. (2) Methods: We retrospectively collected medical data from 1 July 2021 to 1 January 2022 from a total of 71 patients without diabetes who participated in the bariatric clinic with a body mass index (BMI) > 25 kg/m2. Forty-nine participants opted for intragastric botulinum injection (IGBI) using 300 units of botulinum injected into the antrum, body, and fundus, followed with a low-calorie high-protein diet course. Another 22 people participated only in the low-calorie high-protein diet course as a placebo group. This study analyzes the weight loss percentage of the two groups. Adverse events after IGBI are also reported in a safety assessment. (3) Results: In terms of the characteristics of the two groups, the mean BMI was 29.3 kg/m2 in the IGBI group and 28.0 kg/m in the placebo group (p = 0.63 without significant difference). Comparing the percent weight loss from baseline in the two groups after 12 weeks, the IGBI group lost 11.5% of their body weight and the placebo group lost 1.8%. In terms of group analysis, the percentages of participants with a weight reduction of at least 5% for the IGBI and placebo groups were 95% and 4%, respectively. For weight reduction of at least 10%, these values for the IGBI and placebo groups were 63% and 4%, respectively. In terms of adverse events after IGBI for 12 weeks, 12 participants (24.4%) had constipation, which was the main side effect. No serious adverse events were observed during the study period. (4) Conclusion: The combination of a low-calorie high-protein diet and IGBI is an effective and safe procedure in overweight or obese adults for weight reduction, but further larger studies are needed.
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Affiliation(s)
- Po-Ke Hsu
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Weight Control Center, Sun Saint Clinic, Zhubei City 302052, Taiwan;
- Department of Gastroenterology, Changhua Christian Hospital, Changhua City 500209, Taiwan
| | - Chia-Lin Wu
- Department of Nephrology, Changhua Christian Hospital, Changhua City 500209, Taiwan;
| | - Yu-Hsuan Yang
- Department of Weight Control Center, Sun Saint Clinic, Zhubei City 302052, Taiwan;
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40201, Taiwan
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