Intragastric botox injections are used in cases of obesity.


  • With intragastric botox injections, the stomach “empties more slowly and generates a longer-lasting feeling of fullness”


  • There are several published studies on this technique, but they are all very small and their results are quite contradictory to each other.


  • The ECDC warns of several cases of “clinical botulism” in people who have traveled to Turkey to undergo an intervention of this type

“Botox has numerous applications, because what it does is relax the musculature”. Alejandro Mazarro, a surgeon specializing in cosmetic head and neck surgery, explains to NIUS the role of this botulinum neurotoxin. produced by bacteria ‘Clostridium botulinum‘, is used mainly in its specialty, “to relax expression lines” for example. But “That same function of relaxing or paralyzing the muscle can be used for many other things.”notify the doctor.

they are among them intragastric botox injections to lose weight, like those applied in Turkey to the 14 patients now suffering from botulismand of whose cases the ECDC has just warned.

We’re talking about botox injections that what they do is “partially relax the stomach”. For what? Because “it empties more slowly, and generates a longer-lasting feeling of satiety”explains Mazarro. “If you apply Botox directly to the stomach wall, what you do is make that area more relaxed. The muscle loses strength and slows down, it takes longer to empty, so you feel full.”. Hence its supposed usefulness for losing weight. But What are the risks of this intervention? It’s safe? It is efficient?

Trials with few people and conflicting results

There is several published studies about it, but they were all done in very small cohorts, so a few dozen people and also, their results are quite contradictory.s with each other.

For example, this one from 2020 concludes that “Intragastric injection of BTX-A may be beneficial for weight loss. it is a procedure minimally invasive, cost-effective and without serious side effects”. The study was conducted in Turkey and 56 patients participated.

However, a year later, and also in Turkey, we found another study with opposite results. “It was concluded that the application of gastric BTX for weight loss does not provide effective results. In this case, the study was carried out with only 13 patients.

In this other one, published in 2017, Qatari obesity experts reviewed all studies conducted to that date. They concluded that “the use of botox injections in the stomach to treat obesity does not lead to long-term weight loss”. They didn’t find enough evidence for that. Furthermore, they warned possible “harmful side effectssuch as pain and swelling at the injection site, nausea and indigestion”.

“Most of the clinical trials we reviewed showed that although some obese patients who received intragastric endoscopic treatment with BTX-A reported early satiety and delayed gastric emptying, this did not translate into significant or sustained total body weight loss.warn in this review of trials with intragastric injection of Botox.

Also In Spain, experts from Malaga have reviewed all the tests carried out using this procedure and are very critical. regarding the safety and efficacy of this technique. In their article, published in 2017, they conclude that “intragastric injection of botulinum toxin can be effective and safe in the treatment of obesity, but well-designed, placebo-controlled studies with long follow-up and adequate sample size are needed”.

An invasive and temporary procedure

That last one, that weight loss is not sustained over timeThis has been confirmed by several studies. AND they warn also, for example, in Johns Hopkins School of Medicine, in the USA, which performs this type of intervention. “The effect of the injection lasts for about 3 months. And you can repeat the procedure every 6 months”, they guarantee on their website.

According to the information they provide about this technique, “studies show that a successful injection of botulinum toxin into the stomach can result in a weight loss of about 5% to 10% in six months.” They define it as a “minimally invasive” procedure, but in any case, reminds Mazarro, it still is. And it’s something that should always be considered, he says, especially since its benefits are so ephemeral.

You know that it will be something transitory and that it is still invasive, although it is less than other interventions. It will only serve you for a few months. I find little justifiable”, warns the surgeon. If we talk about interventions for this purpose, losing weight, Mazarro is very clear: “Not the most advisable.”

How is the intervention carried out?

What is more, We are not talking about a minor intervention. The procedure is as follows. “You insertn endoscope equipped with a syringe in the mouth, throat and stomach”. It is “a flexible tube with a light and a camera, which This allows the doctor to see where to place the injections.” then the doctor “injects botulinum toxin at various points around the lower part of the stomach.”

At Johns Hopkins, warning about its possible side effects, they explain it. “Botulinum toxin injections into the stomach are safe for people who do not have muscle problems and who are not allergic to botulinum toxin. The injections can result in a very small amount of bleeding inside the stomach. Most people have few or no side effects.” What could have happened to the botulism cases detected in Turkey?

14 cases of botulism, some in the ICU: the cause?

we talk about 14 cases: 12 reported in Germany, one in Switzerland and one in Austria. As for severity, “the clinical presentation of cases varies, from mild to serious”. AND ECDC guarantees that there are several hospitalized people, some of them in Intensive Care Units.

The European organization speaks of “cases of clinical botulismapparently iatrogenicdue to intragastric infection”. And he explains that “the Iatrogenic botulism (that which occurs after the administration of botulinum neurotoxin for therapeutic or cosmetic purposes) it is usually due to an excess in the administered doses”. Its symptoms are “increasing muscular weakness and paralysis that compromises vital functions such as breathing”.

About it overdose, Mazarro explains that when it comes to the stomach, we are talking about a muscle that has nothing to do with the forehead, of course. It’s much thicker. “AND to relax such a thick and powerful muscle you have to use much higher doses”, with the risk that this entails. In the studies discussed, for example, we found doses of 250 or 300 units, compared to doses between 20 and 50 (maximum) that are used in facial aesthetics, to give you an idea.

“Botox is reabsorbed as the muscle is activated. As the stomach is a very large muscle, they give large doses, but the reabsorption will be very quick”, explains the doctor. But in this type of injections, The risk is not only in the use of very high doses, but also in the place where they are injected. “We are talking about 5 times more dose than what is used on a facial level, in aesthetics, but also in an organ that has a lot of vascularization”.

The surgeon warns: “As soon as there is systemic absorption of the product, at blood level, you could have serious complications, it could potentially be serious.

Therefore, the problems can come from two things, As Mazarro explains to NIUS:

  • “for one inadvertent infiltration into a blood vessel”: if it is injected into a vessel, and not into a muscle, botox “circulates through the bloodstream and can have a systemic effect”
  • “for one absorption of the product itself”: because, “since the stomach is a highly vascularized muscle, there can be significant systemic absorption” of the injected botox

the surgeon He confesses to being “shocked” by the use of Botox for these purposes, “there are other more effective alternatives whose safety has already been proven by studies and experiences”, such as the intragastric balloon for example.

O Qatari experts who reviewed all scientific literature in this regard, they are also a very clear warning. “From injecting Botox into the stomach muscles It can have undesirable side effects and, as its effectiveness has not been proven, it is not recommended as a treatment for obesity.”

Turkey and ‘low cost’ medicine

At least ten of the botulism cases detected by the ECDC were operated on in the same hospital in Istanbul between 22nd and 25th February. And five of the cases remember receiving “an intragastric injection of BoNT.”

The ECDC ensures in its report that “there is no evidence, at the moment, that these treatments have been organized by a commercial travel company for medical purposes”. But the truth is Turkey has become a preferred destination for this type of travel, which seeks medical interventions at a lower cost than usual in Europe.

Just a month ago we told the case of Maribel, a woman who traveled to that country to have breast surgery and came back with no teeth. Or the warning given by dentists last summer after detecting hundreds of cases of people who traveled to Turkey to get their teeth fixed and came back with serious complications and real damage in their mouths.”

Mazarro warns: “We are not aware of the danger posed by medical tourism. It is necessary to put the patient’s safety in the first place”. Not to save money, reminds the surgeon, it is necessary take risks that affect health. Because “we are not talking about buying a car and breaking it down, for example, but about something that affects your health”.