Four groups are declined outright, and a fifth is harder to put on a form: patients whose expectations no technique can meet.
We decline gastric botox for four groups: patients with a BMI above roughly 40, patients with an active ulcer or significant gastritis, women who are pregnant or breastfeeding, and anyone with a neuromuscular condition such as myasthenia gravis. Each refusal has a different reason behind it, and none of them becomes negotiable by paying more. A clinic that injects everyone who asks is not screening patients; it is processing them.
Above a BMI of 40 the gap between what botox can deliver and what you actually need is too wide to bridge. Eight to fifteen kilos against a target of sixty is not a start, it is a delay, and an expensive one, because those months are months of untreated diabetes, sleep apnoea and joint load. For those patients the conversation is a sleeve at €3,800 or a bypass at €5,200, and we prefer to have it early.
The injection is placed into the muscle layer through the stomach wall, so an inflamed or ulcerated lining has to be treated and healed first. We gastroscope everyone beforehand and will postpone on the day if what we see calls for it. Significant reflux or a large hiatal hernia is a relative contraindication, since slowing gastric emptying can make reflux worse. Previous stomach surgery changes the anatomy enough that each case is judged individually.
The last group is harder to define on a form. If someone wants a permanent solution, has no intention of changing how they eat, or has been told by three clinics that this counts as obesity surgery, the procedure will disappoint them whatever the technique. We say that at the consultation. Turning down a €900 case costs us less than an unhappy patient, and you can ask us on WhatsApp at +905402555055 first.
Possibly, but not before a gastroscopy and a trial of acid treatment. If the reflux is well controlled and the lining looks healthy we will usually proceed; if it is not, we treat that first or discuss a different route entirely rather than injecting and hoping.
The dose stays in the stomach wall and does not act elsewhere at the amounts used. The exclusion for neuromuscular disease exists because those patients are unusually sensitive to botulinum toxin anywhere in the body, not because the injection travels around it.