Skip to main content
SpringerLink
Log in

A Novel Endoscopic Bariatric Procedure: Results of an Experimental Study

  • New Concept
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Surgical treatment of obesity is characterized by both early and late complications, and thus, there is a need to develop safe and non-invasive techniques. Ghrelin is an orexigenic hormone produced by the fundus of the stomach, which may represent a novel target for obesity management. Unfortunately, numerous attempts to alter ghrelin levels have failed to present significant clinical results. We describe a novel procedure that involves modifying arterial blood flow to the gastric fundus for limiting plasma ghrelin levels.

Methods

A gastroscope was advanced into the gastric fundus of 13 healthy Yorkshire swine, and the fundus was clipped under direct visualization to restrict left gastric artery blood flow. Body weights and ghrelin levels were recorded before and once a week for 4 weeks after the procedure.

Results

Compared to controls, gastroscopic clipping of the fundus decreased plasma ghrelin levels and prevented further weight gain in the 4 weeks of follow-up. Immunohistochemistry and histomorphometry revealed reduced numbers of ghrelin-positive cells in the fundus of experimental animals. We also observed thrombosis in submucosal arteries and submucosal fibrosis. Histological studies demonstrated minimal gastric mucosal injury.

Conclusion

Gastroscopic clipping of the fundus in an experimental porcine model resulted in sustained weight loss and a reduction in plasma ghrelin levels at 1 month post-procedure, with no adverse events. Further experimental studies in human patients are needed to examine the clinical utility of this procedure and to optimize a technique, which can facilitate adequate weight loss while minimizing the risk of mucosal injury.

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.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ng M et al. Global burden of disease study 2013 collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–81.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Güngör NK. Overweight and obesity in children and adolescents. J Clin Res Pediatr Endocrinol. 2014;6(3):129–43.

    Article  PubMed  Google Scholar 

  3. Haslam DW, James WP. Obesity. Lancet. 2005;366(9492):1197–209.

    Article  PubMed  Google Scholar 

  4. Kopelman PG. Obesity as a medical problem. Nature. 2000;404(6778):635–43.

    CAS  PubMed  Google Scholar 

  5. Lean M. Cutting fat absorption to halt weight gain. Practitioner. 1998;242(1593):860–5.

    CAS  PubMed  Google Scholar 

  6. Barness LA. Obesity in children. Fetal Pediatr Pathol. 2007;26(2):75–85.

    Article  CAS  PubMed  Google Scholar 

  7. Barness LA, Opitz JM, Gilbert-Barness E. Obesity: genetic, molecular, and environmental aspects. Am J Med Genet A. 2007;143A(24):3016–34.

    Article  CAS  PubMed  Google Scholar 

  8. Strader AD, Woods SC. Gastrointestinal hormones and food intake. Gastroenterology. 2005;128:175–91.

    Article  CAS  PubMed  Google Scholar 

  9. Cummings DE, Shannon MH. Ghrelin and gastric bypass: is there a hormonal contribution to surgical weight loss? J Clin Endocrinol Metab. 2003;88:2999–3002.

    Article  CAS  PubMed  Google Scholar 

  10. Hu Z, Cha SH, Haasteren G, et al. Effect of centrally administered C75, a fatty acid synthase inhibitor, on ghrelin secretion and its downstream effects. Proc Natl Acad Sci U S A. 2005;102:3972–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Murray CD, Kamm MA, Bloom SR, et al. Ghrelin for the gastroenterologist: history and potential. Gastroenterology. 2003;125:1492–502.

    Article  CAS  PubMed  Google Scholar 

  12. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723–7.

    Article  PubMed  Google Scholar 

  13. Cigaina V. Long-term follow-up of gastric stimulation for obesity: the Mestre 8-year experience. Obes Surg. 2004;14(Suppl 1):S14–22.

    Article  PubMed  Google Scholar 

  14. Hanusch-Enserer U, Cauza E, Brabant G, et al. Plasma ghrelin in obesity before and after weight loss after laparoscopical adjustable gastric banding. J Clin Endocrinol Metab. 2004;89:3352–8.

    Article  CAS  PubMed  Google Scholar 

  15. Leonetti F, Silecchia G, Iacobellis G, et al. Different plasma ghrelin levels after laparoscopic gastric bypass and adjustable gastric banding in morbid obese subjects. J Clin Endocrinol Metab. 2003;88:4227–31.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  17. Inui A, Asakawa A, Bowers CY, et al. Ghrelin, appetite, and gastric motility: the emerging role of the stomach as an endocrine organ. FASEB journal: official publication of the Federation of American Societies for Experimental Biology. 2004;18:439–56.

    Article  CAS  Google Scholar 

  18. Druce MR, Small CJ, Bloom SR. Minireview: gut peptides regulating satiety. Endocrinology. 2004;145:2660–5.

    Article  CAS  PubMed  Google Scholar 

  19. 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 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Joseph B, Berishvili E, Benten D, et al. Isolated small intestinal segments support auxiliary livers with maintenance of hepatic functions. Nat Med. 2004;10(7):749–53.

    Article  CAS  PubMed  Google Scholar 

  23. Kakabadze A, Kakabadze Z. Prospect of using decellularized human placenta and cow placentome for creation of new organs: targeting the liver (part I: anatomic study. Transplant Proc. 2015;47(4):1222–7.

    Article  CAS  PubMed  Google Scholar 

  24. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.

    Article  CAS  PubMed  Google Scholar 

  25. Kumar N. Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration. World J Gastrointest Endosc. 2015;7(9):847–59.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Dansinger ML, Tatsioni A, Wong JB, et al. Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med. 2007;147(1):41–50.

    Article  PubMed  Google Scholar 

  27. Gersin KS, Rothstein RI, Rosenthal RJ, et al. Open-label, sham-controlled trial of an endoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc. 2010;71:976–82.

    Article  PubMed  Google Scholar 

  28. Sullivan S, Stein R, Jonnalagadda S, et al. Aspiration therapy leads to weight loss in obese subjects: a pilot study. Gastroenterology. 2013;145:1245–52.e1-5.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ponce J, Quebbemann BB, Patterson EJ. Prospective, randomized, multicenter study evaluating safety and efficacy of intragastric dual-balloon in obesity. Surg Obes Relat Dis. 2013;9:290–5.

    Article  PubMed  Google Scholar 

  30. Mion F, Ibrahim M, Marjoux S, et al. Swallowable Obalon® gastric balloons as an aid for weight loss: a pilot feasibility study. Obes Surg. 2013;23:730–3.

    Article  PubMed  Google Scholar 

  31. Marinos G, Eliades C, Muthusamy V, et al. First clinical experience with the transpyloric shuttle device, a non-surgical endoscopic treatment for obesity: results from a 3-month and 6-month study. SAGES. 2013: Abstract.

  32. Sauer N, Rösch T, Pezold J, et al. A new endoscopically implantable device (SatiSphere) for treatment of obesity—efficacy, safety, and metabolic effects on glucose, insulin, and GLP-1 levels. Obes Surg. 2013;23:1727–33.

    Article  PubMed  Google Scholar 

  33. Shikora S, Toouli J, Herrera MF, et al. Vagal blocking improves glycemic control and elevated blood pressure in obese subjects with type 2 diabetes mellitus. J Obes. 2013;2013:245683.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Shikora SA, Bergenstal R, Bessler M, et al. Implantable gastric stimulation for the treatment of clinically severe obesity: results of the SHAPE trial. Surg Obes Relat Dis. 2009;5(1):31–7.

    Article  PubMed  Google Scholar 

  35. Diana M, Halvax P, Pop R, et al. Gastric supply manipulation to modulate ghrelin production and enhance vascularization to the cardia: proof of the concept in a porcine model. Surg Innov. 2015;22(1):5–14.

    Article  PubMed  Google Scholar 

  36. Amesur NB, Zajko AB, Philip D, et al. Interventional radiology techniques for intra-arterial chemoembolization. Hepatocell Cancer Curr Clin Oncol. Springer 2005. 215–231.

  37. Bradley EL, Goldman ML. Gastric infarction after therapeutic embolization. Surgery. 1976;79(4):421–4.

    PubMed  Google Scholar 

  38. Brown KT, Friedman WN, Marks RA, et al. Gastric and hepatic infarction following embolization of the left gastric artery: case report. Radiology. 1989;172(3):731–2.

    Article  CAS  PubMed  Google Scholar 

  39. Bilbao JI, Martínez-Cuesta A, Urtasun F, et al. Complications of embolization. Semin intervent Radiol. 2006;23(2):126–42.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Prochaska JM, Flye MW, Johnsrude IS. Left gastric artery embolization for control of gastric bleeding: a complication. Radiology. 1973;107(3):521–2.

    Article  CAS  PubMed  Google Scholar 

  41. Kiyono S, Maruyama H, Kondo T, et al. Hemodynamic effect of the left gastric artery on esophageal varices in patients with cirrhosis. J Gastroenterol. 2016;51(9):900–9.

  42. Waxman I, Saitoh Y, Raju GS, et al. High-frequency probe EUS-assisted endoscopic mucosal resection: a therapeutic strategy for submucosal tumors of the GI tract. Gastrointest Endosc. 2002;55:44–9.

    Article  PubMed  Google Scholar 

  43. Raju GS, Waxman I. High-frequency US probe sonography-assisted endoscopic mucosal resection. Gastrointest Endosc. 2000;52(Suppl 6):S39–49.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Endobar Solutions LLC for funding this research.

Author information

Authors and Affiliations

  1. New York Cardiovascular Research, 1726 2nd Ave., Suite 4S, New York, NY, 10028, USA

    Nickolas Kipshidze & Nodar Kipshidze

  2. N. Kipshidze Central University Hospital, 29 Vazha Pshavela Ave, Tbilisi, Georgia

    Nickolas Kipshidze

  3. NJ Medical Health Associates, 1 Journal Square Plz. Ste. 2, Jersey City, NJ, USA

    Anaka Prakash

  4. College of Global Public Health, New York University, New York, NY, USA

    Nodar Kipshidze

  5. Tbilisi State Medical University, 7 Mikheli Asatianti St, Tbilisi, Georgia

    David Chakhunashvili & Zurab Kakabadze

Authors
  1. Nickolas Kipshidze
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anaka Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nodar Kipshidze
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Chakhunashvili
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zurab Kakabadze
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nickolas Kipshidze.

Ethics declarations

Conflict of Interest

Nickolas Kipshidze is the Founder and major shareholder of Endobar Solutions LLC; Dr. Kipshidze reports research grant from Endobar Solutions, LLC, during the conduct of the study. In addition, author 1 has a patent I.P. pending.

Anaka Prakash—no conflicts of interest.

Nodar Kipshidze—no conflicts of interest.

David Chakhunashvili—no conflicts of interest.

Zurab Kakabadze—no conflicts of interest

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kipshidze, N., Prakash, A., Kipshidze, N. et al. A Novel Endoscopic Bariatric Procedure: Results of an Experimental Study. OBES SURG 26, 3058–3065 (2016). https://doi.org/10.1007/s11695-016-2389-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-016-2389-4

Keywords

Search

Navigation