Bariatric Embolization of the Left Gastric Arteries for the Treatment of Obesity: 9-Month Data in 5 Patients.

Abstract

The purpose of this study is to investigate the safety and 9-month effectiveness of transcatheter left gastric artery embolization (LGAE) for treating patients with obesity. The protocol of this study was approved by the Institutional Ethics Review Board. Five obese patients (3 men and 2 women) with mean weight of 102.0±16.19kg (range, 82.1-125.5kg) and mean body mass index (BMI) of 38.1kg/m2±3.8 (range, 32.9-42.4kg/m2) underwent LGAE with polyvinyl alcohol (PVA) particles in diameter of 500-710μm. The primary endpoint was the safety by grading the adverse events (AEs) according to the Common Terminology Criteria for Adverse Events (CTCAE v4.0) within 30days after LGAE. The secondary endpoints were measured with serum ghrelin and leptin levels, body weight, waist circumference, waist-to-height ratio, and abdominal fat quantity on MRI at the day immediately before LGAE and every 3months after LGAE. LGAE was successfully performed in all patients. A superficial linear ulceration below the cardia was seen in 1 patient 3days after LGAE and healed within 30days. No other serious AEs (grade III or above) occurred. Average body weight loss at 3, 6, and 9months was 8.28±7.3kg (p=0.074), 10.42±8.21kg (p=0.047), and 12.9±14.66kg (p=0.121), respectively. The level of serum ghrelin decreased by 40.83% (p=0.009), 31.94% (p=0.107), and 24.82% (p=0.151) at 3, 6, and 9months after LGAE, respectively. There was minimal reduction of leptin levels at 3 and 6months following LGAE (decreased by 0.26%, p=0.929, and 4.33%, p=0.427, respectively), but it declined obviously 9months after LGAE (decreased by 11.22%, p=0.295). Both waist circumference and waist-to-height ratio decreased after LGAE. MRI showed the area of subcutaneous adipose tissue decreased from the baseline of 400.90±79.25 to 320.36±68.06cm2 (decreased by 20.09%, p=0.006) at 3months, to 328.31±52.67cm2 (decreased by 18.11%, p=0.020) at 6months, and to 286.40±55.72cm2 (decreased by 28.52%, p=0.101) at 9months after LGAE, respectively. But the decrease of abdominal fat loss at 9months after LGAE was largely due to the reduction in visceral adipose tissue. Our study with 9-month data in 5 patients indicates that bariatric embolization of the LGA is a safe and may be a promising strategy to suppress the production of ghrelin and results in weight loss and abdominal fat reduction. ClinicalTrials.gov (NCT02786108).