CardioVascular and Interventional Radiology

, Volume 41, Issue 11, pp 1639–1647 | Cite as

Bariatric Arterial Embolization for Obesity: A Review of Early Clinical Evidence

  • Bin-Yan Zhong
  • Godwin Abiola
  • Clifford R. WeissEmail author


Obesity is a worldwide public health epidemic that leads to increased morbidity, mortality, and cost burden to health care. Although bariatric surgery has been recognized as a standard invasive treatment for obesity, it is accompanied by relatively high morbidity and cost burden, as well as limited treatment outcome. Therefore, alternative treatments with lower morbidity and cost for surgery that target patients who are obese, but not morbidly obese, are needed. A minimally invasive trans-catheter procedure, named bariatric arterial embolization or bariatric embolization (BAE), has been identified as a potential solution, based on its safety and preliminary efficacy profiles. The purpose of this review is to introduce up-to-date clinical data and discuss future directions for BAE for the treatment of obesity.


Obesity Bariatric Embolization Left gastric artery Weight loss 



Dr. Weiss is funded through NIH/NIBIB R01EB017615, NIH/NIBIB T32EB006351, SIR Foundation (FSDG), Siemens Healthcare, BTG, Merit Medical, and Medtronic. Dr. Zhong receives funding through Fundamental Research Funds for the Central Universities, and the Scientific Research Innovation Program for College and University Graduates of Jiangsu Province (KYZZ16_0133). Funding sources have had no involvement in the financial support for the preparation of this article.

Compliance with Ethical Standards

Conflict of interest

Dr. Weiss is a consultant for Medtronic and BTG.


  1. 1.
    Au N, Johnston DW. Too much of a good thing? Exploring the impact of wealth on weight. Health Econ. 2015;24(11):1403–21. Scholar
  2. 2.
    Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.CrossRefGoogle Scholar
  3. 3.
    Bays HE, Toth PP, Kris-Etherton PM, Abate N, Aronne LJ, Brown WV, et al. Obesity, adiposity, and dyslipidemia: a consensus statement from the National Lipid Association. J Clin Lipidol. 2013;7(4):304–83. Scholar
  4. 4.
    Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67. Scholar
  5. 5.
    Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ. 2012;31(1):219–30. Scholar
  6. 6.
    Jones LR, Wilson CI, Wadden TA. Lifestyle modification in the treatment of obesity: an educational challenge and opportunity. Clin Pharmacol Ther. 2007;81(5):776–9. Scholar
  7. 7.
    Lowe MR. Self-regulation of energy intake in the prevention and treatment of obesity: is it feasible? Obes Res. 2003;11(Suppl):44S–59S. Scholar
  8. 8.
    DeMaria EJ. Bariatric surgery for morbid obesity. The New England journal of medicine. 2007;356(21):2176–83. Scholar
  9. 9.
    Jung Y. Role of Endoscopic Gastroplasty Techniques in the Management of Obesity. Clin Endosc. 2017;50(1):21–5. Scholar
  10. 10.
    Vix M, Liu KH, Diana M, D’Urso A, Mutter D, Marescaux J. Impact of Roux-en-Y gastric bypass versus sleeve gastrectomy on vitamin D metabolism: short-term results from a prospective randomized clinical trial. Surg Endosc. 2014;28(3):821–6. Scholar
  11. 11.
    Clinical Guidelines on the Identification. Evaluation, and treatment of overweight and obesity in adults-the evidence report. National Institutes of Health. Obesity research. 1998;6(Suppl 2):51S–209S.Google Scholar
  12. 12.
    Montesi L, El Ghoch M, Brodosi L, Calugi S, Marchesini G, Dalle Grave R. Long-term weight loss maintenance for obesity: a multidisciplinary approach. Diabetes, Metab Syndr Obes Targets Ther. 2016;9:37–46. Scholar
  13. 13.
    Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res. 2004;12(Suppl):151S–62S. Scholar
  14. 14.
    NIH Conference. Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med. 1991;115(12):956–61.CrossRefGoogle Scholar
  15. 15.
    Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, et al. Bariatric surgery versus intensive medical therapy for diabetes–3-year outcomes. N Engl J Med. 2014;370(21):2002–13. Scholar
  16. 16.
    Dumon KR, Murayama KM. Bariatric surgery outcomes. Surg Clin N Am. 2011;91(6):1313–38. Scholar
  17. 17.
    Encinosa WE, Bernard DM, Chen CC, Steiner CA. Healthcare utilization and outcomes after bariatric surgery. Med Care. 2006;44(8):706–12. Scholar
  18. 18.
    Keating C, Neovius M, Sjoholm K, Peltonen M, Narbro K, Eriksson JK, et al. Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study. Lancet Diabet Endocrinol. 2015;3(11):855–65. Scholar
  19. 19.
    Weiner JP, Goodwin SM, Chang HY, Bolen SD, Richards TM, Johns RA, et al. Impact of bariatric surgery on health care costs of obese persons: a 6-year follow-up of surgical and comparison cohorts using health plan data. JAMA Surg. 2013;148(6):555–62. Scholar
  20. 20.
    Srivastava G, Apovian CM. Current pharmacotherapy for obesity. Nat Rev Endocrinol. 2017. Scholar
  21. 21.
    Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–62. Scholar
  22. 22.
    Maahs D, de Serna DG, Kolotkin RL, Ralston S, Sandate J, Qualls C, et al. Randomized, double-blind, placebo-controlled trial of orlistat for weight loss in adolescents. Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2006;12(1):18–28. Scholar
  23. 23.
    Smith SR, Weissman NJ, Anderson CM, Sanchez M, Chuang E, Stubbe S, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. New Engl J Med. 2010;363(3):245–56. Scholar
  24. 24.
    Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9774):1341–52. Scholar
  25. 25.
    Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346(21):1623–30. Scholar
  26. 26.
    Verdam FJ, Schouten R, Greve JW, Koek GH, Bouvy ND. An update on less invasive and endoscopic techniques mimicking the effect of bariatric surgery. J Obes. 2012;2012:597871. Scholar
  27. 27.
    Abu Dayyeh BK, Edmundowicz S, Thompson CC. Clinical practice update: expert review on endoscopic bariatric therapies. Gastroenterology. 2017;152(4):716–29. Scholar
  28. 28.
    Neylan CJ, Dempsey DT, Tewksbury CM, Williams NN, Dumon KR. Endoscopic treatments of obesity: a comprehensive review. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;12(5):1108–15. Scholar
  29. 29.
    Kumar N, Thompson CC. Endoscopic solutions for weight loss. Curr Opin Gastroenterol. 2011;27(5):407–11. Scholar
  30. 30.
    Wren AM, Bloom SR. Gut hormones and appetite control. Gastroenterology. 2007;132(6):2116–30. Scholar
  31. 31.
    Venieratos D, Panagouli E, Lolis E, Tsaraklis A, Skandalakis P. A morphometric study of the celiac trunk and review of the literature. Clin Anat. 2013;26(6):741–50. Scholar
  32. 32.
    Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402(6762):656–60. Scholar
  33. 33.
    Cummings DE, Overduin J. Gastrointestinal regulation of food intake. J Clin Investig. 2007;117(1):13–23. Scholar
  34. 34.
    Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes. 2001;50(8):1714–9.CrossRefGoogle Scholar
  35. 35.
    English PJ, Ghatei MA, Malik IA, Bloom SR, Wilding JP. Food fails to suppress ghrelin levels in obese humans. J Clin Endocrinol Metab. 2002;87(6):2984. Scholar
  36. 36.
    Ravussin Y, Leibel RL, Ferrante AW Jr. A missing link in body weight homeostasis: the catabolic signal of the overfed state. Cell Metab. 2014;20(4):565–72. Scholar
  37. 37.
    Arepally A, Barnett BP, Montgomery E, Patel TH. Catheter-directed gastric artery chemical embolization for modulation of systemic ghrelin levels in a porcine model: initial experience. Radiology. 2007;244(1):138–43. Scholar
  38. 38.
    Arepally A, Barnett BP, Patel TH, Howland V, Boston RC, Kraitchman DL, et al. Catheter-directed gastric artery chemical embolization suppresses systemic ghrelin levels in porcine model. Radiology. 2008;249(1):127–33. Scholar
  39. 39.
    Bawudun D, Xing Y, Liu WY, Huang YJ, Ren WX, Ma M, et al. Ghrelin suppression and fat loss after left gastric artery embolization in canine model. Cardiovasc Intervent Radiol. 2012;35(6):1460–6. Scholar
  40. 40.
    Paxton BE, Kim CY, Alley CL, Crow JH, Balmadrid B, Keith CG, et al. Bariatric embolization for suppression of the hunger hormone ghrelin in a porcine model. Radiology. 2013;266(2):471–9. Scholar
  41. 41.
    Paxton BE, Alley CL, Crow JH, Burchette J, Weiss CR, Kraitchman DL, et al. Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model. J Vasc Interv Radiol. 2014;25(3):455–61. Scholar
  42. 42.
    Paxton BE, Arepally A, Alley CL, Kim CY. Bariatric embolization: pilot study on the impact of gastroprotective agents and arterial distribution on ulceration risk and efficacy in a porcine model. J Vasc Interv Radiol. 2016;27(12):1923–8. Scholar
  43. 43.
    Kim JM, Kim MD, Han K, Muqmiroh L, Kim SU, Kim GM, et al. Bariatric arterial embolization with non-spherical polyvinyl alcohol particles for ghrelin suppression in a swine model. Cardiovasc Intervent Radiol. 2017;40(5):744–9. Scholar
  44. 44.
    Pasciak AS, Bourgeois AC, Paxton BE, Nodit L, Coan PN, Kraitchman D, et al. Bariatric radioembolization: a pilot study on technical feasibility and safety in a porcine model. J Vasc Interv Radiol. 2016;27(10):1509–17. Scholar
  45. 45.
    Diana M, Pop R, Beaujeux R, Dallemagne B, Halvax P, Schlagowski I, et al. Embolization of arterial gastric supply in obesity (EMBARGO): an endovascular approach in the management of morbid obesity. proof of the concept in the porcine model. Obes Surg. 2015;25(3):550–8. Scholar
  46. 46.
    Gunn AJ, Oklu R. A preliminary observation of weight loss following left gastric artery embolization in humans. J Obes. 2014;2014:185349. Scholar
  47. 47.
    Anton K, Rahman T, Bhanushali A, Nadal L, Pierce G, Patel A. Weight loss following left gastric artery embolization in a human population without malignancy: a retrospective review. J Obes Weight Loss Ther 2015;5(6):1–4. CrossRefGoogle Scholar
  48. 48.
    Kipshidze N, Archvadze A, Bertog S, Leon MB, Sievert H. Endovascular Bariatrics: first in Humans Study of Gastric Artery Embolization for Weight Loss. JACC Cardiovasc Interv. 2015;8(12):1641–4. Scholar
  49. 49.
    Syed MI, Morar K, Shaikh A, Craig P, Khan O, Patel S, et al. Gastric artery embolization trial for the lessening of appetite nonsurgically (GET LEAN): six-month preliminary data. Journal of vascular and interventional radiology: JVIR. 2016;27(10):1502–8. Scholar
  50. 50.
    Weiss CR, Akinwande O, Paudel K, Cheskin LJ, Holly B, Hong K, et al. Clinical safety of bariatric arterial embolization: preliminary results of the BEAT obesity trial. Radiology. 2017;283(2):598–608. Scholar
  51. 51.
    Bai ZB, Qin YL, Deng G, Zhao GF, Zhong BY, Teng GJ. Bariatric embolization of the left gastric arteries for the treatment of obesity: 9-month data in 5 patients. Obes Surg. 2018;28(4):907–15. Scholar
  52. 52.
    Bayham BE, Bellanger DE, Hargroder AG, Johnson WD, Greenway FL. Racial differences in weight loss, payment method, and complications following Roux-en-Y gastric bypass and sleeve gastrectomy. Adv Ther. 2012;29(11):970–8. Scholar
  53. 53.
    Shoar S, Saber AA, Aladdin M, Bashah MM, AlKuwari MJ, Rizwan M, et al. Bariatric manipulation of gastric arteries: a systematic review on the potential concept for treatment of obesity. Int Jo Surg. 2016;36(Pt A):177–82. Scholar
  54. 54.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of Radiology, Zhongda Hospital, Medical SchoolSoutheast UniversityNanjingChina
  2. 2.Division of Interventional Radiology, Department of Radiology and Radiologic ScienceJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Johns Hopkins School of MedicineBaltimoreUSA

Personalised recommendations