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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. Weiss
Review

Abstract

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.

Keywords

Obesity Bariatric Embolization Left gastric artery Weight loss 

Notes

Funding

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.

References

  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.  https://doi.org/10.1002/hec.3094.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.jacl.2013.04.001.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/s0140-6736(10)62037-5.CrossRefPubMedPubMedCentralGoogle 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.  https://doi.org/10.1016/j.jhealeco.2011.10.003.CrossRefPubMedGoogle 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.  https://doi.org/10.1038/sj.clpt.6100155.CrossRefPubMedGoogle 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.  https://doi.org/10.1038/oby.2003.223.CrossRefPubMedGoogle Scholar
  8. 8.
    DeMaria EJ. Bariatric surgery for morbid obesity. The New England journal of medicine. 2007;356(21):2176–83.  https://doi.org/10.1056/NEJMct067019.CrossRefPubMedGoogle Scholar
  9. 9.
    Jung Y. Role of Endoscopic Gastroplasty Techniques in the Management of Obesity. Clin Endosc. 2017;50(1):21–5.  https://doi.org/10.5946/ce.2016.147.CrossRefPubMedPubMedCentralGoogle 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.  https://doi.org/10.1007/s00464-013-3276-x.CrossRefPubMedGoogle 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.  https://doi.org/10.2147/DMSO.S89836.CrossRefGoogle 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.  https://doi.org/10.1038/oby.2004.282.CrossRefPubMedGoogle 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.  https://doi.org/10.1056/NEJMoa1401329.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Dumon KR, Murayama KM. Bariatric surgery outcomes. Surg Clin N Am. 2011;91(6):1313–38.  https://doi.org/10.1016/j.suc.2011.08.014.CrossRefPubMedGoogle 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.  https://doi.org/10.1097/01.mlr.0000220833.89050.ed.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/S2213-8587(15)00290-9.CrossRefGoogle 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.  https://doi.org/10.1001/jamasurg.2013.1504.CrossRefPubMedGoogle Scholar
  20. 20.
    Srivastava G, Apovian CM. Current pharmacotherapy for obesity. Nat Rev Endocrinol. 2017.  https://doi.org/10.1038/nrendo.2017.122.CrossRefPubMedGoogle 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.  https://doi.org/10.1210/jc.2014-3415.CrossRefPubMedGoogle 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.  https://doi.org/10.4158/EP.12.1.18.CrossRefGoogle 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.  https://doi.org/10.1056/NEJMoa0909809.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/S0140-6736(11)60205-5.CrossRefPubMedGoogle 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.  https://doi.org/10.1056/NEJMoa012908.CrossRefPubMedGoogle 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.  https://doi.org/10.1155/2012/597871.CrossRefPubMedPubMedCentralGoogle 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.  https://doi.org/10.1053/j.gastro.2017.01.035.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.soard.2016.02.006.CrossRefGoogle Scholar
  29. 29.
    Kumar N, Thompson CC. Endoscopic solutions for weight loss. Curr Opin Gastroenterol. 2011;27(5):407–11.  https://doi.org/10.1097/MOG.0b013e328349e240.CrossRefPubMedGoogle Scholar
  30. 30.
    Wren AM, Bloom SR. Gut hormones and appetite control. Gastroenterology. 2007;132(6):2116–30.  https://doi.org/10.1053/j.gastro.2007.03.048.CrossRefPubMedGoogle 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.  https://doi.org/10.1002/ca.22136.CrossRefPubMedGoogle 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.  https://doi.org/10.1038/45230.CrossRefPubMedGoogle Scholar
  33. 33.
    Cummings DE, Overduin J. Gastrointestinal regulation of food intake. J Clin Investig. 2007;117(1):13–23.  https://doi.org/10.1172/JCI30227.CrossRefPubMedGoogle 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.  https://doi.org/10.1210/jcem.87.6.8738.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.cmet.2014.09.002.CrossRefPubMedPubMedCentralGoogle 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.  https://doi.org/10.1148/radiol.2441060790.CrossRefPubMedGoogle 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.  https://doi.org/10.1148/radiol.2491071232.CrossRefPubMedPubMedCentralGoogle 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.  https://doi.org/10.1007/s00270-012-0362-8.CrossRefPubMedGoogle 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.  https://doi.org/10.1148/radiol.12120242.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.jvir.2013.09.016.CrossRefPubMedPubMedCentralGoogle 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.  https://doi.org/10.1016/j.jvir.2016.07.021.CrossRefPubMedGoogle 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.  https://doi.org/10.1007/s00270-017-1600-x.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.jvir.2016.05.020.CrossRefPubMedGoogle 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.  https://doi.org/10.1007/s11695-014-1535-0.CrossRefPubMedGoogle 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.  https://doi.org/10.1155/2014/185349.CrossRefPubMedPubMedCentralGoogle 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.  https://doi.org/10.4172/2165-7904.1000285 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.  https://doi.org/10.1016/j.jcin.2015.07.016.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.jvir.2016.07.010.CrossRefPubMedGoogle 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.  https://doi.org/10.1148/radiol.2016160914.CrossRefPubMedPubMedCentralGoogle 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.  https://doi.org/10.1007/s11695-017-2979-9.CrossRefPubMedGoogle 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.  https://doi.org/10.1007/s12325-012-0062-4.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.ijsu.2016.10.014.CrossRefGoogle 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.  https://doi.org/10.1001/jama.292.14.1724.CrossRefPubMedGoogle 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

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