Bariatric Arterial Embolization with Non-spherical Polyvinyl Alcohol Particles for Ghrelin Suppression in a Swine Model

Abstract

BAE with PVA particles can transiently suppress ghrelin levels in embolized animals, but levels are not significantly different compared to controls. Stomach ulcerations were identified in 60% of the embolized animals.

Bariatric Arterial Embolization: Effect of Microsphere Size on the Suppression of Fundal Ghrelin Expression and Weight Change in a Swine Model

“…The use of a Surefire antireflux catheter instead of a standard end-hole catheter, although it prevents reflux, may pressurize the system such that communicating vessels in the swine stomach may be embolized, leading to non-target bead deposition. Additionally, the ulceration rate we observed might be explained by the timing of endoscopy at 1 week after embolization instead of at 3 weeks, as reported in other preclinical studies (21,32). pigs embolized with smaller microspheres highlights the need to balance safety and efficacy when choosing embolic particle size before clinical translation.…”

“…However, liquid sclerosing agents are toxic and difficult to deliver accurately (17,19). Insoluble biocompatible embolic particles are currently used for both oncologic and nononcologic applications (19,20,24,(31)(32)(33). In animal studies, bariatric embolization with embolic particles has resulted in decreased serum ghrelin levels, statistically significant weight loss (19), or reduced weight gain (20,32) at up to 8 weeks.…”

“…Insoluble biocompatible embolic particles are currently used for both oncologic and nononcologic applications (19,20,24,(31)(32)(33). In animal studies, bariatric embolization with embolic particles has resulted in decreased serum ghrelin levels, statistically significant weight loss (19), or reduced weight gain (20,32) at up to 8 weeks. Gastric ulceration was noted in nearly half of a very small number of pigs (n = 5 or 6) embolized with small (40-µm) or intermediate-sized (50-to 250-µm) particles, regardless of the number of vessels embolized (20,32,34).…”

“…In animal studies, bariatric embolization with embolic particles has resulted in decreased serum ghrelin levels, statistically significant weight loss (19), or reduced weight gain (20,32) at up to 8 weeks. Gastric ulceration was noted in nearly half of a very small number of pigs (n = 5 or 6) embolized with small (40-µm) or intermediate-sized (50-to 250-µm) particles, regardless of the number of vessels embolized (20,32,34). No adverse events or gastric ulceration was observed in animals embolized with larger (500-to 700-µm) particles (19,21).…”

Transradial left gastric artery embolization to treat severe obesity: A pilot study

“…A major concern regarding gastric embolization is the risk of gastric mucosal ulceration, erosion, or gastritis. This has been observed in porcine experimental models and in three of the aforementioned pilot studies . However, in all human cases, the course was benign with healing documented on follow‐up gastroscopy.…”