Prof. Dr. Toygar Toydemir
He received the title of Professor of General Surgery in 2020. Dr. Toydemir, who has extensive experience in reflux and obesity surgery, continues his work in these fields. You can read the rest of our article about Gastric Botox prices, treatment process, and post-treatment precautions.
Read More Make an AppointmentGastric Botox is a modern treatment method applied to support weight loss. In this procedure, botulinum toxin A (BTA) is injected into the stomach muscles to slow gastric motility and provide an early feeling of fullness. Theoretically, by extending gastric emptying time, it may reduce food intake. However, scientific research has yielded conflicting results regarding the effectiveness of this method. While some studies have observed positive effects on weight loss and satiety, others have not found a significant difference. Therefore, more research is needed on the effectiveness of gastric Botox. Treatment decisions should be made based on a detailed medical evaluation for each individual.
The medical use of botulinum toxin historically began with recognizing the therapeutic potential of the poison. First identified in the 19th century as the cause of botulism, the toxin was examined in the second half of the 20th century for its therapeutic properties. In the 1970s, Dr. Alan B. Scott’s use of botulinum toxin type A for strabismus treatment opened the door to clinical applications. This groundbreaking step laid the foundation for the use of the toxin in various neurological and muscular disorders.
Research on the effects of botulinum toxin on the gastrointestinal (GI) system began in the 1990s. In 1994, a study by Pasricha and colleagues demonstrated the toxin’s potential in treating GI motility disorders. These experiments in piglets confirmed its ability to relax muscles by reducing lower esophageal sphincter pressure, showing it could be applied safely. These findings made its use in conditions such as achalasia and gastroparesis possible.
The idea of using gastric Botox for weight loss stems from the hypothesis that it relaxes stomach muscles by blocking acetylcholine release at the neuromuscular junction, resulting in early satiety. Early animal studies yielded promising results, leading to human studies. However, clinical trials have shown conflicting results: some found no significant effect on weight loss, while others reported positive outcomes in certain patient groups. Today, it is used as an alternative method for patients who prefer to avoid surgery.
Gastric Botox is generally considered in cases of obesity treatment or resistant gastroparesis. However, this procedure may not be suitable for everyone. Appropriate patient selection is crucial for achieving effective and safe results.
Obesity Treatment:
Gastric Botox may be considered for individuals who do not respond to traditional weight loss methods. Body Mass Index (BMI) is typically an important criterion in determining candidates for gastric Botox, which is suitable for those with a BMI over 25 kg/m².
Additionally, patients who are not suitable for or decline bariatric surgery may also be evaluated for gastric Botox. For such patients, gastric Botox stands out as a non-invasive alternative.
Treatment-Resistant Gastroparesis:
Gastroparesis is a condition in which the stomach cannot empty food at a normal pace, often causing bloating, nausea, and early satiety. In individuals who do not respond to standard therapies, gastric Botox may be applied to reduce contractions in the pyloric sphincter, aiming to improve gastric emptying. However, there is no clear scientific consensus on its effectiveness for gastroparesis, and treatment outcomes vary from patient to patient.
Limitations and Considerations:
The effects of gastric Botox are temporary, usually lasting 4–6 months. Therefore, long-term feasibility and the necessity for repeated injections must be taken into account when deciding on treatment. Although gastric Botox is generally safe, side effects such as abdominal pain and nausea may occur, albeit rarely. Patient monitoring and prompt management of side effects are essential during treatment.
Gastric Botox may not be a suitable treatment option for certain individuals. Firstly, caution should be exercised in patients with neuromuscular disorders. For instance, in patients with myasthenia gravis, amyotrophic lateral sclerosis (ALS), or Lambert-Eaton syndrome, the mechanism by which botulinum toxin inhibits acetylcholine release could exacerbate existing muscle weakness, leading to serious complications.
Patients at risk of allergic reactions are also not eligible for gastric Botox. In particular, individuals with sensitivities to human albumin or lactose contained in the botulinum toxin formulation may experience allergic reactions ranging from localized skin symptoms to life-threatening anaphylaxis.
The safety of gastric Botox for pregnant and breastfeeding women has not yet been fully established, so it is generally avoided in these circumstances. A careful risk-benefit assessment must be carried out. Similarly, patients taking aminoglycoside antibiotics or drugs that affect neuromuscular transmission should be considered at risk because the effects of the toxin may be intensified.
In patients with bleeding disorders or those on anticoagulant therapy, there is a risk of hematoma or bleeding during injection. Furthermore, in individuals with spinal cord injuries prone to autonomic dysreflexia, gastric Botox may cause severe complications. Lastly, in those with unrealistic expectations, treatment outcomes could lead to psychological distress.
Gastric Botox is generally performed with an endoscopic procedure under light sedation, prioritizing patient comfort. During the procedure, an anesthesiologist administers sedative medications to ensure the patient’s comfort. This allows the procedure to be completed painlessly.
The procedure begins with a thin, lighted endoscope equipped with a camera being inserted through the mouth into the stomach. The endoscope makes it possible to directly visualize the stomach lining and accurately determine the areas to be injected. Injections are usually made into the antrum portion of the stomach. Targeting the antrum slows gastric emptying, helping prolong the feeling of satiety.
Using a special injection needle passed through the working channel of the endoscope, the physician injects the botulinum toxin. The dose of the toxin and the number of injection sites are determined based on the patient’s individual characteristics and the procedure protocol. The procedure typically concludes within 15–20 minutes.
After injections are complete, the endoscope is carefully withdrawn, and the patient is monitored in a recovery room. Vital signs are observed until the sedative wears off, and potential complications are assessed. Once the patient is completely stable, they are discharged, and detailed post-procedure care instructions are provided.
Although gastric Botox is generally considered a safe procedure, it carries some side effects and risks of complications. Commonly reported side effects include gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and bloating. These symptoms are typically mild and resolve on their own without intervention. For instance, in a study of 25 obese patients, only two experienced temporary abdominal pain and diarrhea.
In some cases, patients may also experience chest pain and heartburn. This is particularly rare, but possible in treatments aimed at esophageal motility disorders. In a large-scale retrospective analysis of 661 procedures, only 29 were found to have such mild complications.
Although serious complications are rare, they should be carefully evaluated. Gastric ulcers and perforations have been reported following gastric Botox. Such complications are generally related to injection technique and precautions taken during the procedure. Infections—particularly acute mediastinitis—are rare but may lead to serious outcomes. Allergic reactions may also occur, and in some cases, anaphylaxis may arise, requiring emergency intervention.
The complication rate may be influenced by factors such as patient selection, application technique, and dosage used.
Gastric Botox draws attention as a treatment option aimed at supporting weight loss. However, scientific literature presents conflicting outcomes regarding its effectiveness. A 2020 systematic review and meta-analysis showed that gastric Botox did not create a significant difference in weight loss or Body Mass Index (BMI) reduction compared to saline injections. However, the injections of botulinum toxin A (BTA) were found to significantly prolong gastric emptying time.
The dose and injection technique applied can greatly influence the effectiveness of gastric Botox. A 2022 meta-analysis revealed that higher doses of BTA and multiple injection sites, combined with dietary control, may enhance weight loss. In particular, using 200 units or more of BTA resulted in a difference of −2.04 kg, while multiple injection sites yielded −4.44 kg of weight loss.
Patient selection also plays a critical role in the success of this treatment. Notably, patients with a BMI over 40 kg/m² were reported to have more limited weight loss. This finding suggests that gastric Botox may be more effective in individuals with moderate obesity.
Some clinical studies support that gastric Botox can have positive effects on appetite control and feelings of fullness. However, more research is needed to reach a general consensus on its effectiveness. Treatment decisions should be made on an individual basis.
A detailed preparation process before a gastric Botox procedure is crucial for ensuring the treatment is carried out safely and effectively. Initially, a comprehensive medical evaluation is conducted to determine if the procedure is suitable for you. Gastric Botox is generally recommended for individuals with a BMI of 25–40 who have not achieved sufficient results with diet and exercise. Those with allergies to botulinum toxin, neuromuscular disorders, or active stomach problems undergo a special assessment prior to the procedure.
Patients are typically required to fast for about 8 hours to keep the stomach empty. This measure lowers the risk of aspiration and provides a clearer view during endoscopic visualization. Additionally, it is important to inform your doctor about any regular medications. In particular, blood thinners or medications that affect gastric motility may be temporarily suspended or have their doses adjusted by your physician.
As the procedure is performed on an outpatient basis, you can usually be discharged on the same day. However, because sedation is administered, you will not be able to drive after the procedure, so transportation arrangements should be made in advance. You are also advised to wear comfortable clothing and leave valuable items at home. A brief recovery period on-site is required, during which the healthcare team will evaluate for any complications or complaints.
Post-procedure care following gastric Botox is critical for ensuring the effectiveness and safety of the treatment. A short observation period is initially applied, during which patients are monitored for any allergic reactions or complications. Most patients can return to daily activities one day after the procedure.
Adequate hydration during the recovery process supports healing. During the first few days, a liquid-based diet is recommended, followed by a gradual reintroduction of solid foods. Adopting a balanced diet helps maintain weight loss goals after the procedure.
Caution is also advised regarding physical activities. Intensive exercise should be avoided during the first 24 hours after the procedure.
Patients should carefully monitor their symptoms and promptly consult a healthcare professional if they notice unusual signs (such as muscle weakness or vision problems). Attending planned follow-up appointments is important for tracking progress and identifying any issues that may arise.
Finally, informing healthcare professionals about any ongoing medications and implementing healthy lifestyle changes can enhance the procedure’s effectiveness. Regular physical activity, healthy eating, and stress management are key factors supporting long-term success.
References
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