Laparosc Endosc Surg Sci . 2020; 27(1): 30-33 | DOI: 10.14744/less.2020.94557

The importance of the structure of pylorus in the success of the gastric botulinum toxin injections

Murat Kanlýöz¹, Uður Ekici², Faik Tatlý³, Turgay Karataþ^4
1Çankaya University, Ankara, Turkey
²Department of General Surgery, Ýstanbul Geliþim University, Ýstanbul, Turkey
³Department of General Surgery, Harran University Faculty of Medicine, Þanlýurfa, Turkey
⁴Department of Anatomy, Ýnönü University Faculty of Medicine, Malatya, Turkey

INTRODUCTION: In clinical practices, our success rate proved lower in patients with hypotonic pylorus who underwent gastric botulinum toxin A (GBTA) injection. To analyze this methodologically, we researched how considering the pyloric structure contributes to the treatment success in GBTA injection.
METHODS: This study included 196 patients who underwent GBTA injection between 2017 and 2018. We measured their body mass indexes (BMI) before treatment (BT) and six months after treatment (AT). Upon no contraindications in the endoscopy, we applied GBTA 200 U to the patients. During the endoscopy, we named the pylori able to strain & relax spontaneously or by a stimulus and close firmly as normotonic pylorus (NP) and patients unable to close firmly and respond to the stimulus as hypotonic pylorus (HP). The patients were analyzed under three groups: G1, G2 and G3, which included patients with NP, HP and NP (+) HP, respectively. In independent group comparisons, we used the Mann-Whitney U test. Further, we made the dependent group comparisons using the Wilcoxon paired sample test. In all tests, a level of 0.05 was considered significant.
RESULTS: Of the patients, 63.8% (125) were female and 36.2% (71) were male. Their mean age was 32.27±9.2 years. 148 and 48 of the patients had NP and HP, respectively. The median BMIs of groups were as follows: 35.5 (27.4–48) kg/m2 BT and 32.55 (24–44.1) kg/m2 AT in G3 with -2.95 kg/m2 variation (p=0.048*), 35.7 (27.4–48) kg/m2 BT and 32.35 (24–42.8) kg/m2 AT in G1 with -3.35 kg/m2 variation (p=0.036*), 35.1 (29–46.2) kg/m2 BT and 34.15 (27.9–44.1) kg/m2 AT in G2 with -0.95 kg/m2 variation (p=0.098).
DISCUSSION AND CONCLUSION: We recommend administering GBTA injection therapy especially to the patients with NP.

Keywords: Bariatric endoscopy, botulinum toxin; obesity; pyloric structure

---

Gastrik botilinum toksin A uygulamalarýndaki baþarýda pilor yapýsýnýn önemi

Murat Kanlýöz¹, Uður Ekici², Faik Tatlý³, Turgay Karataþ^4
1Çankaya Üniversitesi, Ankara, Türkiye
²Istanbul Geliþim Üniversitesi, Genel Cerrahi Anabilim Dalý, Ýstanbul, Türkiye
³Harran Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý, Þanlýurfa, Türkiye
⁴Inönü Üniversitesi Týp Fakültesi Anatomi Anabilim Dalý, Malatya, Türkiye

GÝRÝÞ ve AMAÇ: Klinik gözlemlerimize göre gastrik botilinum toksin A (GBTA) tedavisi uyguladýðýmýz hastalardan hipotonik pilorlu hastalarda baþarý oranlarýmýzýn düþüktü. Gözlemlerimizi metodolojik temelde analiz etmek için GBTA uygulamasýnda pilor yapýsýný dikkate almanýn tedavi baþarýsýna katkýsýný araþtýrmak istedik.
YÖNTEM ve GEREÇLER: 2017-2018 yýllarý arasýnda GBTA uygulanan 196 hasta çalýþmaya alýndý. Hastalarýn tedavi öncesinde (BT) ve tedaviden altý ay sonra (AT) vücut kütle indeksleri (BMI) ölçüldü. Hastalara yapýlan endoskopide kontrendikasyon yoksa ayný seansta GBTA 200 U uygulandý. Endoskopi esnasýnda pilor spontan veya endoskopla yapýlan uyaranla kasýlýp gevþeyebiliyorsa ve tam kapanýyorsa normotonik pilor (NP), tam kapanmýyorsa, uyarana da yanýt vermiyor ve açýk kalýyorsa hipotonik pilor (HP) olarak adlandýrýldý. Hastalar G1, G2 ve G3 adý altýnda üç grupta incelendi. G1’de NP, G2’de HP, G3’de NP(+)HP hastalarý vardý.Baðýmsýz grup karþýlaþtýrmalarýnda Mann-Whitney U testi kullanýlmýþtýr. Baðýmlý grup karþýlaþtýrmalarýnda ise Wilcoxon eþleþtirilmiþ iki örneklem testi uygulanmýþtýr.Tüm testlerde anlamlýlýk düzeyi 0,05 olarak kabul edilmiþtir.
BULGULAR: Çalýþmaya katýlanlarýn %63,8’i (125) kadýn, %36,2’si (71) erkekti. Yaþ ortalamasý 32,27±9,2 yýl. Hastalardan 148’i NP, 48’i HP’du. G3’de BT median BMI 35,5 (27,4-48) kg/m2, AT 32,55 (24-44,1) kg/m2, deðiþim -2,95 kg/m2 (p=0,048). G1’de BT median BMI 35,7 (27,4-48) kg/m2, AT 32,35 (24-42,8) kg/m2, deðiþim -3,35 kg/m2 (p=0,036). G2’de BT median BMI 35,1 (29-46,2) kg/m2, AT 34,15 (27,9-44,1) kg/m2, deðiþim -0,95 kg/m2 (p=0,098).
TARTIÞMA ve SONUÇ: GBTA tedavisinin özellikle NP hastalara uygulanmasýný önermekteyiz.

Anahtar Kelimeler: Bariatrik endoskopi, botilinum toksin; obezite; pilor yapýsý

---

CITE