By Arshan Dehbozorgi, MS4, University of Missouri School of Medicine
Obesity is a health problem that has raised great concern in the last few decades, particularly due to its alarmingly increasing prevalence and numerous adverse health outcomes. By some estimates, close to a third of Americans are obese (1). Obesity is associated with myriad health conditions such as liver disease, heart disease, stroke, type 2 diabetes, obstructive sleep apnea, hyperlipidemia, and gout (2). Bariatric surgery has become an efficacious and established method for management of severe obesity. This procedure is often performed after failed medical therapy and lifestyle modifications. Some of the more common types of bariatric procedures include Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. With regards to weight loss and health improvement, studies have shown that surgical intervention often leads to superior outcomes compared to non-surgical intervention (2). However, invasive procedures are associated with more risks, complications, and longer hospital stays.
Excitingly, there is a new, minimally invasive procedure developed by interventional radiologists that may lead to outcomes similar to those of the aforementioned invasive procedures, but with low risk of complications. This procedure is called bariatric arterial embolization (BAE). Interventional radiologists use angiography to selectively embolize the left gastric artery, which leads to the suppression of ghrelin. Ghrelin is a hormone that increases appetite and food intake; suppression of this hormone is believed to lead to weight loss.
Kipshidze et al. performed the first human study of BAE. They released a report of five patients who underwent particle embolization of the left gastric artery and measured blood ghrelin level and weight outcomes and compared them to baseline. There were no periprocedural complications and three patients reported temporary post-procedural epigastric discomfort. In as little as week, patients reported decreased appetite. At 20-24 month follow-up, the average weight loss was approximately 22 kg. Plasma ghrelin levels decreased by 29%, 36%, 19%, and 21% at 1, 3, 6, and 12 month follow-up, respectively (3).
Another study that reported positive outcomes included 19 adults with an average BMI of roughly 45. The study participants worked with an interdisciplinary team and were instructed on lifestyle and diet changes before and after the procedure. No major adverse events were reported in any of the patients, and in fact, six patients were discharged the evening of their procedure. The average excessive weight loss at 1, 3, 6, and 12 months were 8.4%, 11.5%, 18.3%, and 12.6%, respectively. Ghrelin levels were reduced by an average of 17.5% after 3 months (4). Although this study reinforces the benefits of BAE as a safe method for treatment of obesity, more trials with larger groups of participants are necessary to confirm the efficacy and benefit of BAE.
Gastric Artery Embolization Trial for Lessening Appetite Nonsurgically (GET LEAN), led by Syed et al, is another study evaluating the role of BAE. At 3 months, average weight loss was 7%, and estimated body weight (EBW) loss was 14%. At 6 months, average weight loss was 8.5%, and EBW loss was 17.2%. At one year, one patient had 48 lb weight loss (49% EBW). Weight loss after BAE was associated with other health benefits. Notably, one diabetic experienced an A1C drop from 7.4% to 6.3% in three months (5).
Chamsudin et al. in a single center study evaluated 12 patients who underwent BAE for weight reduction and appetite control. All patients were discharged the day of the procedure, and monthly weights were obtained. Several patients complained of subjective burning sensation during the first few meals. All patients reported a decrease in their appetite, which persisted until the 9-month follow-up. Initial BMI of 30.5 decreased to 27 at this follow-up (6).
The above studies are a few examples of how BAE can provide an efficacious, less invasive treatment for obesity. Although these studies have promising results, further evaluation of the safety and efficacy of this procedure is needed. For additional information, please see references below.
1) Lane, Erin. “How Interventional Radiology Can Help BEAT Obesity.” The Advisory Board Company. N.p., n.d. Web. 04 Nov. 2016.
2) Weiss, C. R., Gunn, A. J., Kim, C. Y., Paxton, B. E., Kraitchman, D. L., & Arepally, A. (2015). Bariatric Embolization of the Gastric Arteries for the Treatment of Obesity. Journal of Vascular and Interventional Radiology, 26(5), 613-624
3) Kipshidze, N., Sievert, H., Bertog, S., Archvadze, A., & Leon, M. B. (2015). Transcatheter Left Gastric Artery Therapy for Treating Obesity. Circulation, 132(Suppl 3), A19840-A19840
4) Weiss, C. R., Gunn, A. J., Kim, C. Y., Paxton, B. E., Kraitchman, D. L., & Arepally, A. (2017). Bariatric embolization of arteries for the treatment of obesity (BEAT Obesity): 6-12 month safety and efficacy data.
5) Syed, Mubin I. “Gastric Artery Embolization Trial for Lessening Appetite Nonsurgically, Results at 6 Months.”Http://www.gestweb.org/symposium/images/Presentations/Abstracts_-_Saturday/pm1200_SyedDr_Gastric_Saturday.pdf. Web.
6) Chamsuddin, A., & Achou, R. (2016). Gastric artery embolization for appetite control and weight loss, a single center experience. Journal of Vascular and Interventional Radiology, 3(27), S9-S10.
Other interesting articles about the topic include:
Radiology, Dayton Interventional. “Doctors Perform First U.S. Bariatric Embolization Procedure to Treat Obesity.” PR Newswire: Press Release Distribution, Targeting, Monitoring and Marketing. N.p., n.d. Web. 25 Nov. 2016.
“Interventional Radiologists Discover Potential New Approach to Treat Obesity.” Massachusetts General Hospital. N.p., n.d. Web. 04 Dec. 2017.