番茄社区

CHICAGO -- An experimental procedure in which the left gastric artery was embolized through a catheter-based system was associated with weight loss, including 50% reductions in excess weight, researchers reported here.

The percutaneous procedure, called bariatric or gastric artery embolization, has been attempted in four morbidly obese patients, with subsequent weight loss of a few pounds to nearly 50 lb in one woman who was carrying about 100 lb of excess weight, said of Dayton Interventional Radiology in Ohio.

"Bariatric embolization is a promising treatment for obesity. It can be performed on an outpatient basis and has the potential to provide as much weight loss as is seen in gastric surgery," said Syed at a press conference at Radiological Society of North America (RSNA) meeting.

Syed said that he believes that gastric artery embolization reduces the hormone ghrelin, also known as the "hunger hormone." He also said that embolizing the left gastric artery does not appear to harm the stomach because the organ has a rich collateral blood supply.

He said that one of the four patients was a diabetic who lost 26 lb or 17% of excess body weight after the procedure. "We are waiting to perform the procedure on a fifth patient...we have a waiting list of patients who want to undergo the procedure, Syed told 番茄社区.

But the procedure was only approved by the for five patients in order to determine if the study should be expanded, Syed explained.

The larger Gastric Artery Embolization Trial for Lessening Appetite Nonsurgically () is currently recruiting and will assess the safety and efficacy of the device in patients undergoing left gastric artery embolization for morbid obesity.

The pilot study will enroll morbidly obese patients (body mass index >40 kg/m²) who are otherwise healthy. Eligible patients must weigh less than 400 lb and be ages 22-65. Patients must also have failed previous attempts at weight loss through diet, exercise, and behavior modification.

Syed said that the procedure takes about 1 hour to complete and that patients can be sent home after a short in-clinic recovery time, usually about 4 hours.

In the patients Syed reported on at RSNA, the procedure was successfully completed in one patient using the radial artery route. This meant that puncturing the femoral artery in the groin, an area that can be difficult to access in morbidly obese individuals, was avoided, Syed said, adding that excessive bleeding at the puncture site is a possibility if sealing devices fail.

Of the four patients who had been treated with the percutaneous procedure, one patient lost 48 lb, or 48.6% of her excess body weight, at 1-year follow-up, Syed reported.

Another diabetic patient shed 26 lb in 3 months, while a third patient lost 6 lb, and a fourth patient lost 9 lb after 6 months. Syed explained that the patient who only lost 6 lb had depressive symptoms at baseline. This patient had a depressive event during the trial and may have overeaten to compensate for the depression, he added.

Otherwise, "there were no major adverse among the four patients," he said. Stomach ulcerations occurred in three patients, but were superficial and resolved without incident.

Syed cautioned that stomach perforation is an adverse event that is associated with the procedure, but other adverse event risks are similar to other percutaneous procedures, such as bleeding at the puncture site, reaction to contrast agents, and exposure to radiation.

However, Syed stressed that the procedure is not ready for prime-time. "The long-term risks and results of bariatric embolization are not yet known," he cautioned. "This required further research. Bariatric surgery remains the standard of care in these morbidly obese patients if diet and exercise fails."

In commenting on the study, of Stanford University Medical Center in Stanford, Calif., told 番茄社区 that "we are just sort of dipping out toe in the water here with this small study. However, this concept has been brought up before so we are all kind of eagerly waiting to see more data."

"We have seen that patients lose weight after left gastric artery embolizations when those procedures are done in urgent bleeding cases," Hovsepian noted. "We really don't understand the mechanism of action. The bariatric surgeons have gotten very good with their procedure but there are still complications."

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