Bariatric Embolization of the Gastric Arteries for the Treatment of Obesity

Abstract

Obesity is a public health epidemic in the United States, which results in significant morbidity, mortality, and cost to the healthcare system. Despite advancements in therapeutic options for the bariatric patients, the number of overweight and obese individuals continues to rise. Thus, complimentary or alternative treatments to lifestyle changes and surgery are urgently needed. Embolization of the left gastric artery, or ‘bariatric arterial embolization’, has been shown to modulate body weight in animal models and early clinical studies. If successful, bariatric arterial embolization represents a potential minimally invasive approach to treat obesity offered by interventional radiologists. The purpose of the following review will be to introduce the interventional radiologist to bariatric arterial embolization by presenting its physiologic and anatomic bases, reviewing the pre-clinical and clinical data, and discussing current and future investigations.

Changes in ghrelin, leptin and ınsulin levels after laparoscopic sleeve gastrectomy

“…Leptin levels in circulation increase with presence of obesity and decrease with weight loss (25). Plasma levels of leptin increase during and after eating (26). In a study conducted by Kalinowski et al (9), leptin levels decreased significantly 1 month after surgery and continued to decrease at 6 and 12 months after LSG.…”

Comparison of Weight Loss, Ghrelin, and Leptin Hormones After Ligation of Left Gastric Artery and Sleeve Gastrectomy in a Rat Model

“…Leptin is a hormone that is mainly produced by adipocytes; it promotes energy expenditure and reduces hepatic gluconeogenesis and insulin resistance [12]. Plasma levels of leptin increase during and after eating [13]. Studies have shown that ghrelin and leptin levels decrease after bariatric surgery [14].…”

Analysis of weight changes after left gastric artery embolization in a cancer-naive population

“…Despite advances in medical research and surgical techniques, obesity remains one of the largest drivers of chronic disease and healthcare costs in the United States (2,3). In response to the growing obesity epidemic, left gastric artery (LGA) embolization has evolved as a promising procedure for weight loss therapy (4,5).…”

“…LGA embolization has been shown to suppress serum ghrelin levels and modulate weight in animal models (4,5,7). Promising results in animal models prompted investigators to retrospectively evaluate patients who underwent LGA embolization, an established procedure in interventional radiology for treatment of gastrointestinal (GI) bleeding.…”

“…Early retrospective studies, though limited by small sample sizes and potential confounding factors, demonstrated significant weight loss as a nonintended side effect of LGA embolization and showed promise for reproducibility in humans. Results from clinical trials investigating the utility of LGA embolization to modulate weight have demonstrated promising results (4)(5)(6)(8)(9)(10)(11)(12)(13)(14)(15). However, studies have been limited to small sample sizes and long-term data are lacking.…”