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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

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Abstract

Background

Embolization of the left gastric artery (LGA) reduces circulating levels of ghrelin, but might prevent from further obesity surgery, particularly sleeve gastrectomy (SG), since the gastroesophageal junction (GEJ), depending on LGA, would be devascularized. Our aim was to evaluate, in an experimental animal study, an endovascular approach targeting arteries of the gastroepiploic arcade aiming to modulate ghrelin levels and to generate an increased vascular supply of the GEJ to reduce the risks of staple-line leaks after SG.

Methods

Seven pigs underwent embolization of both left and right gastroepiploic arteries (LGEA and RGEA) using 500–700-μ microspheres (embolization of arterial gastric supply in obesity (EMBARGO)-alpha). A SG was performed in six pigs 3 weeks after EMBARGO-alpha and on eight controls. Capillary lactates were measured at the cardia and pylorus. Five pigs underwent coiling of RGEA and embolization of LGEA using both coils and 100–300-μ microspheres (EMBARGO-beta). Ghrelin levels were assessed before and once per week after both EMBARGOs. Control celiac trunk angiography was performed at 3 weeks (alpha) and 4 weeks (beta).

Results

No significant ghrelin reduction was obtained with EMBARGO-alpha at 3 weeks when compared to baseline. Significant ghrelin reduction was found 3 weeks (p = 0.0363) and 4 weeks (p = 0.025) after EMBARGO-beta. Post-EMBARGO-alpha animals presented a significantly lower increase in cardia lactates when compared to controls after SG. Control angiography showed a significantly increased fundic vascular network in 5/6 animals after EMBARGO-alpha and in 5/5 after EMBARGO-beta.

Conclusions

EMBARGO is effective to decrease ghrelin production and can enhance the vascular supply of the GEJ, preparing the vascular background for a SG.

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Acknowledgments

The authors are grateful to Mourad Bouhadjar, Gaël Fourré, and Franck Blindauer, radiology technicians at the IHU Surgical Institute, for their valuable assistance in performing experimental procedures. The authors would also like to thank Nicolas Morin, animal care technician, and Rodrigo Carraro, senior veterinarian, for the careful follow-up of experimental subjects. Finally, the authors would like to acknowledge Christopher Burel, medical English reviewer, for his valuable help in proofreading the manuscript. This study was funded through internal resources originating from the IHU-Strasbourg Minimally Invasive Image-Guided Surgical Institute “Feasibility Study Research Grant” and received no corporate input. Coils used in this study were kindly provided by Penumbra, Inc., which was not involved in the study design or data acquisition.

Conflict of Interest

Michele Diana, Raoul Pop, Rémy Beaujeux, Bernard Dallemagne, Peter Halvax, Isabel Schlagowski, Yu-Yin Liu, Pierre Diemunsch, Bernard Geny, Veronique Lindner, and Jacques Marescaux have no conflicts of interest.

Animal Rights Statement

All applicable institutional and national guidelines for the care and use of animals were followed.

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Authors and Affiliations

  1. University Institute of Image-Guided Surgery, IHU-Strasbourg, 1, Place de l’Hôpital, 67091, Strasbourg, France

    Michele Diana, Raoul Pop, Rémy Beaujeux, Peter Halvax & Jacques Marescaux

  2. IRCAD, Research Institute against Cancer of Digestive System, Strasbourg, France

    Michele Diana, Bernard Dallemagne, Yu-Yin Liu & Jacques Marescaux

  3. Physiology Institute, Research Unit on Oxidative Stress and Mitochondria (EA 3072), University of Strasbourg, Strasbourg, France

    Michele Diana, Isabel Schlagowski & Bernard Geny

  4. Department of Anesthesia, University Hospital of Strasbourg, Strasbourg, France

    Pierre Diemunsch

  5. Pathology Department, University Hospital of Strasbourg, Strasbourg, France

    Veronique Lindner

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  1. Michele Diana
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  2. Raoul Pop
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  3. Rémy Beaujeux
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  4. Bernard Dallemagne
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  5. Peter Halvax
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  6. Isabel Schlagowski
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  7. Yu-Yin Liu
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  8. Pierre Diemunsch
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  9. Bernard Geny
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  10. Veronique Lindner
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  11. Jacques Marescaux
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Correspondence to Michele Diana.

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Diana, M., Pop, R., Beaujeux, R. 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 25, 550–558 (2015). https://doi.org/10.1007/s11695-014-1535-0

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  • DOI: https://doi.org/10.1007/s11695-014-1535-0

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