Bariatric Embolization of the Left Gastric Arteries for the Treatment of Obesity: 9-Month Data in 5 Patients
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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.
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.
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.
KeywordsBariatric embolization Left gastric artery Obesity Weight loss Ghrelin
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).
Compliance with Ethical Standards
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.
- 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
- 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.
- 25.Morais T, Andrade S, Pereira SS, et al. Vaccines for metabolic diseases: current perspectives. Vaccine (Auckl). 2014;4:55–72.Google Scholar
- 27.Gunn AJ, OkluR. A preliminary observation of weight loss following left gastric artery embolization in humans. J Obes. 2014;2014:185349.Google Scholar
- 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.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.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.Google Scholar