EUS-Guided Intragastric Injection of Botulinum Toxin A in the Preoperative Treatment of Super-Obese Patients: a Randomized Clinical Trial

Moura, Eduardo Guimarães Hourneaux de; Ribeiro, Igor Braga; Frazão, Mariana Souza Varela; Mestieri, Luiz Henrique Mazzonetto; Moura, Diogo Turiani Hourneaux de; Bó, Creusa Maria Roveri Dal; Brunaldi, Vítor Ottoboni; Nunes, Giovana Barros; Bustamante, Fabio; Neto, Manoel dos Passos Galvão; Matuguma, Sérgio; Bernardo, Wanderley Marques; Santo, Marco Aurélio

doi:10.1007/s11695-018-3470-y

Cited by 39 publications

(34 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…EUS-guided interventions are increasingly advanced and are used for various therapeutic purposes (18) . EUS-guided coil combined with cyanoacrylate in order to reduce the risk of embolism in the treatment of gastric varices was first described in 2011 (7) .…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Eus-Guided Coil Plus Cyanoacrylate Versus Conventional Cyanoacrylate Technique in the Treatment of Gastric Varices: A Randomized Controlled Trial

Lôbo

Chaves

Moura

et al. 2019

Arq. Gastroenterol.

Self Cite

View full text Add to dashboard Cite

BACKGROUND: One of the most feared complications with the use of cyanoacrylate for treatment of gastric varices is the occurrence of potentially life-threatening systemic embolism. Thus, endoscopists are turning towards new techniques, including endoscopic coiling, as a potentially safer and more effective treatment option. However, no studies have been performed comparing the two techniques. OBJECTIVE: This study aims to compare the safety and efficacy of endoscopic ultrasound guided coil and cyanoacrylate injection versus the conventional technique of injection of cyanoacrylate alone. DESIGN: A pilot randomized controlled trial. METHODS: Patients randomized into group I were treated with coil and cyanoacrylate, and those in group II with cyanoacrylate alone. Flow within the varix was evaluated immediately after the treatment session and one month following initial treatment. If thrombosis was confirmed, additional follow-up was performed 4 and 10 months following initial treatment. All patients underwent a thoracic computerized tomography scan after the procedure. RESULTS: A total of 32 patients, 16 in each group, were followed for an average of 9.9 months (range 1-26 months). Immediately after the procedure, 6 (37.5%) group-I patients and 8 (50%) group-II patients presented total flow reduction in the treated vessel (P=0.476). After 30 days, 11 (73.3%) group-I patients and 12 (75%) group-II patients were found to have varix thrombosis. In both groups, the majority of patients required only one single session for varix obliteration (73.3% in group I versus 80% in group II). Asymptomatic pulmonary embolism occurred in 4 (25%) group-I patients and 8 (50%) group-II patients (P=0.144). No significant difference between the groups was observed. CONCLUSION: There is no statistical difference between endoscopic ultrasound guided coils plus cyanoacrylate versus conventional cyanoacrylate technique in relation to the incidence of embolism. However, a greater tendency towards embolism was observed in the group treated using the conventional technique. Both techniques have similar efficacy in the obliteration of varices. Given the small sample size of our pilot data, our results are insufficient to prove the clinical benefit of the combined technique, and do not yet justify its use, especially in light of higher cost. Further studies with larger sample size are warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Eus-Guided Coil Plus Cyanoacrylate Versus Conventional Cyanoacrylate Technique in the Treatment of Gastric Varices: A Randomized Controlled Trial

Lôbo

Chaves

Moura

et al. 2019

Arq. Gastroenterol.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Unfortunately, most of the major adverse events were related to unrecognized intraoperative mucosal perforation. Some recent studies (7,37,38) found no difference in adverse events or efficacy after treatment with POEM vs Heller in patients treated with different previous therapies (dilation, Botox, and surgery) (4,7,21,(38)(39)(40)(41) . However, a separate prior study by Ren et al (42) showed a higher complication rate in POEM, perhaps related to the learning curve.…”

Section: Discussionmentioning

confidence: 99%

Peroral (Poem) or Surgical Myotomy for the Treatment of Achalasia: A Systematic Review and Meta-Analysis

Martins

Ribeiro

Moura

et al. 2020

Arq. Gastroenterol.

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Achalasia is a neurodegenerative motility esophageal disorder characterized by failure of lower esophageal sphincter relaxation. The conventional treatment option for achalasia has been laparoscopic Heller myotomy (LHM). However, in 2010, Inoue et al. described peroral endoscopic myotomy (POEM), a minimally invasive procedure, as an alternative therapy. To date, some studies with small sample sizes have aimed to compare outcomes of LHM vs POEM. OBJECTIVE: Thus, the aim of this study is to perform a systematic review and meta-analysis to better evaluate the efficacy and safety of these two techniques. METHODS: Individualized search strategies were developed from inception through April 2019 in accordance with PRISMA guidelines. Variables analyzed included operative time, overall adverse events rate, post-procedure gastroesophageal reflux disease (GERD), hospitalization length, post-procedure pain score, and Eckardt Score reduction. RESULTS: Twelve cohort trials were selected, consisting of 893 patients (359 in POEM group and 534 in LHM.) No randomized clinical trials were available. There was no difference in operative time (MD= -10,26, 95% CI (-5,6 to 8,2), P<0.001) or Post-Operative Gastroesophageal Reflux (RD: -0.00, 95%CI: (-0.09, 0.09), I2: 0%). There was decreased length of hospital stay for POEM (MD: -0.6, 95% CI (-1.11, -0.09), P=0.02), and an increased mean reduction in Eckardt score in POEM patients (MD = -0.257, 95% CI: (-0.512 to -0.002), P=0.048), with similar rates of adverse events. CONCLUSION: POEM demonstrated similar results compared to laparoscopic Heller myotomy with regards to improvement of dysphagia, post-procedure reflux, and surgical time, with the benefit of shorter length of hospital stay. Therefore, POEM can be considered an option for patients with achalasia.

show abstract

“…Natomiast w innych badaniach klinicznych nie obserwowano korzystnego wpływu toksyny botulinowej na masę ciała i czas opróżniania żołądka [27,28]. Najnowsze badania wskazują również na brak jej skuteczności w zmniejszaniu wagi przed operacjami u osób bardzo otyłych [29]. Te sprzeczne doniesienia mogą wynikać z różnic dotyczących miejsc podania toksyny, zastosowanych dawek oraz kryteriów doboru pacjentów.…”

Section: Nowe Kierunki Zastosowania Toksyny Botulinowejunclassified

The possibilities of using botulinum toxin beyond the dermatology

Zwierzyńska¹,

Zawistowska²,

Pietrzak³

2018

Farm Pol.

View full text Add to dashboard Cite

The possibilities of using botulinum toxin beyond the dermatology · Botulinum toxin which is a neurotoxin produced by the bacteria Clostridium botulinum, is one of the most active and best-known biological toxins. Its mechanism of action is associated with proteolysis of specific proteins and prevention of release acetylocholine at presynaptic terminals in neuromuscular junctions. Botulinum toxin is mainly used in aesthetic medicine for reduction of wrinkles and in excessive sweating. Recently, it has been also used beyond the dermatology e.g. in the treatment of migraines, dystonia, bruxism or overactive bladder. Moreover, its beneficial effects on reducing depression and weight loss in obese people are currently investigated in observation and clinical trials.

show abstract

EUS-Guided Intragastric Injection of Botulinum Toxin A in the Preoperative Treatment of Super-Obese Patients: a Randomized Clinical Trial

Abstract: Intragastric injection of BTX-A does not appear to be an effective method of achieving preoperative weight loss in super-obese patients.

Cited by 39 publications

References 46 publications

Safety and Efficacy of Eus-Guided Coil Plus Cyanoacrylate Versus Conventional Cyanoacrylate Technique in the Treatment of Gastric Varices: A Randomized Controlled Trial

Safety and Efficacy of Eus-Guided Coil Plus Cyanoacrylate Versus Conventional Cyanoacrylate Technique in the Treatment of Gastric Varices: A Randomized Controlled Trial

Peroral (Poem) or Surgical Myotomy for the Treatment of Achalasia: A Systematic Review and Meta-Analysis

The possibilities of using botulinum toxin beyond the dermatology

Contact Info

Product

Resources

About