Abstract
Introduction: Obesity is associated with adverse cardiovascular and metabolic conditions. Dietary, medical or surgical weight loss strategies are frequently unsuccessful and/or accompanied by risks. Ghrelin, produced in the gastric fundus, stimulates food intake. Catheter-directed left Gastric Artery Embolization (GAE) causes a reduction in plasma ghrelin levels and weight loss in an animal model. The effect of GAE on ghrelin levels and weight in humans is unknown. Aim: Purpose of this study was an initial assessment of safety and efficacy of GAE in humans. Methods: Five obese patients underwent left GAE with BeadBlock Embolic Bead 300-500μm microspheres (Biocompatibles UK Limited, UK). Esophagogastroscopy was performed in all patients before and after GAE and at 1-week follow-up to assess for gastritis or ulcers after the procedure. Weight and fasting plasma ghrelin levels were obtained at baseline and 1-, 3-, 6- and 12-month follow-up. Results: The procedure was successful in all patients with no periprocedural complications. Three of 5 patients complained about mild, transient postprocedural epigastric pain. However, gastroscopy did not reveal any abnormalities. Significant progressive weight loss accompanied by reductions in plasma ghrelin levels was observed in all patients at all follow-up: mean initial weight (128.12±24.4kg) decreased to 106±21kg (p<0.001) at 20-24-month follow-up and plasma ghrelin levels (initially 473±189) decreased by 29%, 36%, 19% and 21% at 1-, 3-, 6- and 12-month follow-up (p<0.05). Conclusions: Percutaneous left gastric artery embolization with embolic beads as described in our study appears safe. It leads to a reduction in plasma ghrelin levels and is accompanied by a significant weight loss at intermediate term follow-up. Further studies with larger patient numbers and perhaps use of dedicated device are needed to examine the utility of this procedure and to determine the best procedural technique that allows adequate mucosal injury and ghrelin reduction while minimizing the risk of ulcer formation.
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