Skip to main content

Advertisement

SpringerLink
Log in

Bariatric Embolization of the Left Gastric Arteries for the Treatment of Obesity: 9-Month Data in 5 Patients

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to investigate the safety and 9-month effectiveness of transcatheter left gastric artery embolization (LGAE) for treating patients with obesity.

Materials and Methods

The protocol of this study was approved by the Institutional Ethics Review Board. Five obese patients (3 men and 2 women) with mean weight of 102.0 ± 16.19 kg (range, 82.1–125.5 kg) and mean body mass index (BMI) of 38.1 kg/m2 ± 3.8 (range, 32.9–42.4 kg/m2) underwent LGAE with polyvinyl alcohol (PVA) particles in diameter of 500–710 μm. The primary endpoint was the safety by grading the adverse events (AEs) according to the Common Terminology Criteria for Adverse Events (CTCAE v4.0) within 30 days after LGAE. The secondary endpoints were measured with serum ghrelin and leptin levels, body weight, waist circumference, waist-to-height ratio, and abdominal fat quantity on MRI at the day immediately before LGAE and every 3 months after LGAE.

Results

LGAE was successfully performed in all patients. A superficial linear ulceration below the cardia was seen in 1 patient 3 days after LGAE and healed within 30 days. No other serious AEs (grade III or above) occurred. Average body weight loss at 3, 6, and 9 months was 8.28 ± 7.3 kg (p = 0.074), 10.42 ± 8.21 kg (p = 0.047), and 12.9 ± 14.66 kg (p = 0.121), respectively. The level of serum ghrelin decreased by 40.83% (p = 0.009), 31.94% (p = 0.107), and 24.82% (p = 0.151) at 3, 6, and 9 months after LGAE, respectively. There was minimal reduction of leptin levels at 3 and 6 months following LGAE (decreased by 0.26%, p = 0.929, and 4.33%, p = 0.427, respectively), but it declined obviously 9 months after LGAE (decreased by 11.22%, p = 0.295).

Both waist circumference and waist-to-height ratio decreased after LGAE. MRI showed the area of subcutaneous adipose tissue decreased from the baseline of 400.90 ± 79.25 to 320.36 ± 68.06 cm2 (decreased by 20.09%, p = 0.006) at 3 months, to 328.31 ± 52.67 cm2 (decreased by 18.11%, p = 0.020) at 6 months, and to 286.40 ± 55.72 cm2 (decreased by 28.52%, p = 0.101) at 9 months after LGAE, respectively. But the decrease of abdominal fat loss at 9 months after LGAE was largely due to the reduction in visceral adipose tissue.

Conclusions

Our study with 9-month data in 5 patients indicates that bariatric embolization of the LGA is a safe and may be a promising strategy to suppress the production of ghrelin and results in weight loss and abdominal fat reduction.

Trial Registration

ClinicalTrials.gov (NCT02786108).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  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.

    Article  PubMed  Google Scholar 

  2. Asiseh F, Yao J. Family income and body mass index—what have we learned from China. Heal Econ Rev. 2016;6(1):52.

    Article  Google Scholar 

  3. Bays HE, Toth PP, Kris-Etherton PM, et al. Obesity, adiposity, and dyslipidemia: a consensus statement from the National Lipid Association. J Clin. 2013;7(4):304–83.

    Google Scholar 

  4. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.

    Article  PubMed  Google Scholar 

  5. Jung Y. Role of endoscopic gastroplasty techniques in the management of obesity. Clin Endosc. 2017;50(1):21–5.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370:2002–13.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Varban OA, Cassidy RB, Bonham A, et al. Factors associated with achieving a body mass index of less than 30 after bariatric surgery. JAMA Surg JAMA Surg. 2017; https://doi.org/10.1001/jamasurg.2017.2348.

  8. Chang SH, Stoll CR, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149:275–87.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Allen JW. Laparoscopic gastric band complications. Med Clin N Am. 2007;91:485–97.

    Article  PubMed  Google Scholar 

  10. Abu Dayyeh BK, Edmundowicz S, Thompson CC. Clinical practice update: expert review on endoscopic bariatric therapies. Gastroenterology. 2017;152(4):716–29.

    Article  PubMed  Google Scholar 

  11. Neylan CJ, Dempsey DT, Tewksbury CM, et al. Endoscopic treatments of obesity: a comprehensive review. Surg Obes Relat Dis. 2016;12(5):1108–15.

    Article  PubMed  Google Scholar 

  12. Koehestanie P, de Jonge C, Berends FJ, et al. The effect of the endoscopic duodenal-jejunal bypass liner on obesity and type 2 diabetes mellitus, a multicenter randomized controlled trial. Ann Surg. 2014;260(6):984–92.

    Article  PubMed  Google Scholar 

  13. Arepally A, Barnett BP, Montgomery E, et al. Catheter-directed gastric artery chemical embolization for modulation of systemic ghrelin levels in a porcine model: initial experience. Radiology. 2007;244(1):138–43.

    Article  PubMed  Google Scholar 

  14. Arepally A, Barnett BP, Patel TH, et al. Catheter-directed gastric artery chemical embolization suppresses systemic ghrelin levels in porcine model. Radiology. 2008;249(1):127–33.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bawudun D, Xing Y, Liu WY, et al. Ghrelin suppression and fat loss after left gastric artery embolization in canine model. Cardiovasc Intervent Radiol. 2012;35(6):1460–6.

    Article  PubMed  Google Scholar 

  16. Paxton BE, Alley CL, Crow JH, et al. Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model. J Vasc Interv Radiol. 2014;25(3):455–61.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Paxton BE, Kim CY, Alley CL, et al. Bariatric embolization for suppression of the hunger hormone ghrelin in a porcine model. Radiology. 2013;266(2):471–9.

    Article  PubMed  Google Scholar 

  18. Kipshidze N, Archvadze A, Bertog S, et al. Endovascular bariatrics: first-inman of left gastric artery embolization for weight loss. JACC Cardiovasc Interv. 2015;8(12):1641–4.

    Article  PubMed  Google Scholar 

  19. Syed MI, Morar K, Shaikh A, et al. Gastric artery embolization trial for the lessening of appetite nonsurgically (GET LEAN): six-month preliminary data. J Vasc Interv Radiol. 2016;27(10):1502–8.

    Article  PubMed  Google Scholar 

  20. Weiss CR, Akinwande O, Paudel K, et al. Clinical safety of bariatric arterial embolization: preliminary results of the BEAT obesity trial. Radiology. 2017;283(2):598–608.

    Article  PubMed  Google Scholar 

  21. Mihalache L, Gherasim A, Niță O, et al. Effects of ghrelin in energy balance and body weight homeostasis. Hormones (Athens). 2016;15(2):186–96.

    Article  Google Scholar 

  22. Esler WP, Rudolph J, Claus TH, et al. Small-molecule ghrelin receptor antagonists improve glucose tolerance, suppress appetite, and promote weight loss. Endocrinology. 2007;148(11):5175–85.

    Article  CAS  PubMed  Google Scholar 

  23. Lu SC, Xu J, Chinookoswong N, et al. An acyl-ghrelin-specific neutralizing antibody inhibits the acute ghrelin-mediated orexigenic effects in mice. Mol Pharmacol. 2009;75(4):901–7.

    Article  CAS  PubMed  Google Scholar 

  24. Andrade S, Pinho F, Ribeiro AM, et al. Immunization against active ghrelin using virus-like particles for obesity treatment. Curr Pharm Des. 2013;19(36):6551–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Morais T, Andrade S, Pereira SS, et al. Vaccines for metabolic diseases: current perspectives. Vaccine (Auckl). 2014;4:55–72.

    CAS  Google Scholar 

  26. Prochaska JM, Flye MW, Johnsrude IS. Left gastric artery embolization for control of gastric bleeding: a complication. Radiology. 1973;107:521–2.

    Article  CAS  PubMed  Google Scholar 

  27. Gunn AJ, OkluR. A preliminary observation of weight loss following left gastric artery embolization in humans. J Obes. 2014;2014:185349.

  28. Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol In Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–2497.

  29. Kangas S, Timonen P, Knuuttila M, et al. Waist circumference and waist-to-height ratio are associated with periodontal pocketing—results of the Health 2000 Survey. BMC Oral Health. 2017;17(1):48.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Levitt MR, Morton RP, Haynor DR, et al. Angiographic perfusion imaging: real-time assessment of endovascular treatment for cerebral vasospasm. J Neuroimaging. 2014;24:387–92.

    Article  PubMed  Google Scholar 

  31. Meeks MDME, Mayer J, Desgranges P, et al. Evaluation of infrapopliteal blood flow changes during endovascular revascularization using 2D X-ray perfusion software: a pilot study. Poster presented at CIRSE 2014, Glasgow, UK. Abstract nr 296.

  32. Ravussin Y, Leibel RL, Ferrante Jr AW. A missing link in body weight homeostasis: the catabolic signal of the over fed state. Cell Metab. 2014;20(4):565–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Hursting SD. Obesity, energy balance, and cancer: a mechanistic perspective. Cancer Treat Res. 2014;159:21–33.

    Article  CAS  PubMed  Google Scholar 

  34. Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab. 2008;93:S57–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Moller JB, Pedersen M, Tanaka H, et al. Body composition is the main determinant for thedifference in type 2 diabetes pathophysiology between Japanese and Caucasians. Diabetes Care. 2014;37(3):796–804.

    Article  PubMed  Google Scholar 

  36. Hwang YC, Hayashi T, Fujimoto Y, et al. Visceral abdominal fat accumulation predicts the conversion of metabolically healthy obese subjects to an unhealthy phenotype. Int J Obes. 2015;39(9):1365–70.

    Article  CAS  Google Scholar 

  37. Fischer K, Pick JA, Moewes D, et al. Qualitative aspects of diet affecting visceral and subcutaneous abdominal adipose tissue: a systematic review of observational and controlled intervention studies. Nutr Rev. 2015;73(4):191–215.

    Article  PubMed  Google Scholar 

  38. Baum T, Cordes C, Dieckmeyer M, et al. MR-based assessment of body fat distribution and characteristics. Eur J Radiol. 2016;85(8):1512–8.

    Article  PubMed  Google Scholar 

  39. Matsuzawa Y, Shimomura I, Nakamura T, et al. Pathophysiology and pathogenesis of visceral fat obesity. Obes Res. 1995; Suppl 2:187S–194S.

  40. Fujimoto WY, Abbate SL, Kahn SE, et al. The visceral adiposity syndrome in Japanese-American men. Obes Res. 1994;2(4):364–71.

    Article  CAS  PubMed  Google Scholar 

  41. Banerji MA, Faridi N, Atluri R, et al. Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab. 1999;84:137–44.

    CAS  PubMed  Google Scholar 

  42. Galanakis CG, Daskalakis M, Manios A, et al. Computed tomography-based assessment of abdominal adiposity changes and their impact on metabolic alterations following bariatric surgery. World J Surg. 2014;39:417–23.

    Article  Google Scholar 

  43. Toro-Ramos T, Goodpaster BH, Janumala I, et al. Continued loss in visceral and intermuscular adipose tissue in weight-stable women following bariatric surgery. Obesity. 2015;23:62–9.

    Article  PubMed  Google Scholar 

  44. Kim MK, Kim W, Kwon HS, et al. Effects of bariatric surgery on metabolic and nutritional parameters in severely obese Korean patients with type 2 diabetes: a prospective 2-year follow up. J Diabetes Investig. 2014;5:221–7.

    Article  CAS  PubMed  Google Scholar 

  45. Yoon DY, Kim HK, Kim JA, et al. Changes in the abdominal fat distribution after gastrectomy: computed tomography assessment. ANZ J Surg. 2007;77:121–5.

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by Jiangsu Provincial Special Program of Medical Science (BL2013029), China; National Basic Research Program of China (973 Program # 2013CB733800, 2013733803), and National Natural Science Foundation of China (81230034, 81520108015).

Author information

Authors and Affiliations

  1. Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhong-Da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China

    Zhi-Bin Bai, Yong-Lin Qin, Gang Deng, Guo-Feng Zhao, Bin-Yan Zhong & Gao-Jun Teng

Authors
  1. Zhi-Bin Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong-Lin Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gang Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guo-Feng Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bin-Yan Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gao-Jun Teng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gao-Jun Teng.

Ethics declarations

The protocol of this study was approved by our Institutional Ethics Review Board (IERB)

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bai, ZB., Qin, YL., Deng, G. et al. Bariatric Embolization of the Left Gastric Arteries for the Treatment of Obesity: 9-Month Data in 5 Patients. OBES SURG 28, 907–915 (2018). https://doi.org/10.1007/s11695-017-2979-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-2979-9

Keywords

Search

Navigation