Bariatric Arterial Embolization Research Articles

Bariatric arterial embolization slows gastric emptying and improves postprandial glycaemia in obese dogs with impaired glucose tolerance.

To evaluate the effects of bariatric arterial embolization (BAE) on gastric emptying of, and the glycaemic response to, an oral glucose load in an obese canine model with impaired glucose tolerance. Eleven male dogs were fed a high-fat, high-fructose diet for 7 weeks before receiving BAE, which involved selective embolization of the left gastric artery (n = 5; 14.9 ± 0.8 kg), or the sham (n = 6; 12.6 ± 0.8 kg) procedure. Postprocedural body weight was measured weekly for 4 weeks. Prior to and at 4 weeks postprocedure, a glucose solution containing 13C-acetate was administered orally for evaluation of the gastric half-emptying time (T50) and the glycaemic response. The relationship between the changes in the blood glucose area under the curve over the first 60 minutes (AUC0-60min) and the T50 was also assessed. At 4 weeks postprocedure, BAE reduced body weight (BAE vs. the sham procedure: -5.7% ± 0.9% vs. 3.5% ± 0.9%, P < .001), slowed gastric emptying (T50 at baseline vs. postprocedure: 75.5 ± 2.0 vs. 82.5 ± 1.8 minutes, P = .021 in the BAE group; 73.8 ± 1.8 vs. 74.3 ± 1.9 minutes in the sham group) and lowered the glycaemic response to oral glucose (AUC0-60min at baseline vs. postprocedure: 99.2 ± 13.7 vs. 67.6 ± 9.8 mmol·min/L, P = .043 in the BAE group; 100.2 ± 13.4 vs. 103.9 ± 14.6 mmol·min/L in the sham group). The change in the glucose AUC0-60min correlated inversely with that of the T50 (r = -0.711; P = .014). In a canine model with impaired glucose tolerance, BAE, while reducing body weight, slowed gastric emptying and attenuated the glycaemic response to an oral glucose load.

Bariatric arterial embolization in patients with body mass index ranging from 25 to 40 kg/m2: A systematic review & meta-analysis.

The present review sought to evaluate by meta-analysis the efficacy of bariatric arterial embolization (BAE) in promoting weight loss in patients with body mass index (BMI) ranging from 25-40 kg/m2. This study was performed and reported according to Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. A systematic literature search of MEDLINE, Embase Google Scholar, and World Health Organization Library database was done for studies evaluating BAE for promoting weight loss in patients with BMI ranging from 25-40 kg/ m2 published up to March 10, 2021. Primary outcome measure included weight loss after the embolisation procedure. Three single-arm studies comprising of a total of 28 patients (BMI: 25- 40 kg/m2) were found eligible for meta-analysis. All patients underwent embolization with either Embosphere microspheres or PVA particles. The predominant artery embolised was left gastric artery (in all patients). Additional arteries embolised included gastroepiploic artery (8 patients), or accessory left gastric artery (1 patient), or short gastric artery (1 patient). Pooled absolute mean weight loss was 7.854 kg (95% CI: 6.103-9.605). No significant statistical heterogeneity was detected (I2=51.75%, P=0.126) among pooled studies. In conclusion, limited single-arm studies report BAE as an effective, and relatively safe procedure for promoting weight loss in patients with BMI ranging from 25-40 kg/m2, although the number of patients included is very small. Initial results of BAE in promoting weight loss are promising with no major/severe complications reported; however, long term follow-up is required to see the sustainability of the effects.

TCT-298 Bariatric Arterial Embolization: A Mini-Invasive Procedure for Treating Obesity

TCT-298 Bariatric Arterial Embolization: A Mini-Invasive Procedure for Treating Obesity

Balancing Safety and Efficacy to Determine the Most Suitable Size of Imaging-Visible Embolic Microspheres for Bariatric Arterial Embolization in a Preclinical Model

ObjectivesTo identify the most suitable size of imaging-visible embolic agents with balanced safety and efficacy for bariatric arterial embolization (BAE) in a preclinical model. Materials and MethodsTwenty-seven pigs were divided into 3 cohorts. In Cohort I, 16 pigs were randomized to receive (n = 4 each) 40–100-μm microspheres in 1 or 2 fundal arteries, 70–340-μm radiopaque microspheres in 2 fundal arteries, or saline. In Cohort II, 3 pigs underwent renal arterial embolization with either custom-made 100–200-μm, 200–250-μm, 200–300-μm, or 300–400-μm radiopaque microspheres or Bead Block 300–500 μm with microsphere distribution assessed histologically. In Cohort III, 8 pigs underwent BAE in 2 fundal arteries with tailored 100–200-μm radiopaque microspheres (n = 5) or saline (n = 3). ResultsIn Cohort I, no significant differences in weight or ghrelin expression were observed between BAE and control animals. Moderate-to-severe gastric ulcerations were noted in all BAE animals. In Cohort II, renal embolization with 100–200-μm microspheres occluded vessels with a mean diameter of 139 μm ± 31, which is within the lower range of actual diameters of Bead Block 300–500 μm. In Cohort III, BAE with 100–200-μm microspheres resulted in significantly lower weight gain (42.3% ± 5.7% vs 51.6% ± 2.9% at 8 weeks; P = .04), fundal ghrelin cell density (16.1 ± 6.7 vs 23.6 ± 12.6; P = .045), and plasma ghrelin levels (1,709 pg/mL ± 172 vs 4,343 pg/mL ± 1,555; P < .01) compared with controls and superficial gastric ulcers (5/5). ConclusionsIn this preclinical model, tailored 100–200-μm microspheres were shown to be most suitable for BAE in terms of safety and efficacy.

Interventional metabology: A review of bariatric arterial embolization and endovascular denervation for treating metabolic disorders.

The rising prevalence of metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM) poses a major challenge to global health. Existing therapeutic approaches have limitations, and there is a need for new, safe, and less invasive treatments. Interventional metabolic therapy is a new addition to the treatment arsenal for metabolic disorders. This review focuses on two interventional techniques: bariatric arterial embolization (BAE) and endovascular denervation (EDN). BAE involves embolizing specific arteries feeding ghrelin-producing cells to suppress appetite and promote weight loss. EDN targets nerves that regulate metabolic organs to improve glycemic control in T2DM patients. We describe the current state of these techniques, their mechanisms of action, and the available safety and effectiveness data. We also propose a new territory called "Interventional Metabology" to encompass these and other interventional approaches to treating metabolic disorders.

Abstract No. 166 ▪ FEATURED ABSTRACT Bariatric Arterial Embolization is Associated with Significant Muscle-Sparing Weight Loss Detected by Whole-Body Magnetic Resonance Imaging Anthropometry

Abstract No. 166 ▪ FEATURED ABSTRACT Bariatric Arterial Embolization is Associated with Significant Muscle-Sparing Weight Loss Detected by Whole-Body Magnetic Resonance Imaging Anthropometry

Association Between Gut Hormones and Weight Change After Bariatric Arterial Embolization: Results from the BEAT Obesity Trial.

To evaluate associations of ghrelin, glucagon-like peptide 1 (GLP-1), and peptide YY 3-36 (PYY3-36) with weight change after bariatric arterial embolization (BAE). Subgroup analysis of data collected during the BEAT Obesity Trial involving 7 participants with BMI > 40 who were embolized with 300- to 500-μm Embosphere Microspheres. Three participants were characterized as "responders" (top tertile of weight loss at each visit) and 4 as "non-responders" (bottom tertile of weight loss at each visit). Mean ± standard deviation participant age was 44 ± 11years, and 6 of 7 participants were women. Participants were evaluated at baseline, 2weeks, and 1, 3, 6, and 12months after BAE. After fasting, participants consumed a mixed meal test at each visit; blood samples were collected at 0, 15, 30, 60, 120, 180, and 240min. Study outcome measures were changes in weight from baseline and plasma serum hormone levels. Percentage change in ghrelin decreased significantly in non-responders at 60 and 120min at 1 and 12months (estimated difference between 60 vs. 0min at 1month: 69% [95% CI - 126%, - 13%]; estimated difference between 120 vs. 0min at 12months: - 131% (95% CI - 239%, - 23%]). Responders had significantly lower ghrelin and greater weight loss than non-responders at 6 and 12months. GLP-1 and PYY3-36 levels did not differ between groups. Participants with consistent weight loss throughout follow-up had lower ghrelin than non-responders, supporting decreased ghrelin as a mechanism underlying BAE-induced weight loss. High-quality randomized trial or prospective study; testing of previously developed diagnostic criteria on consecutive patients; sensible costs and alternatives; values obtained from many studies with multiway sensitivity analyses; systematic review of Level I RCTs and Level I studies.

Comparison of Soluble Gelatin Sponge Particles and Tris-acryl Gelatin Microspheres for Bariatric Arterial Embolization in Swine

The purpose of this study was to compare complications and the number of ghrelin-expressing cells (GECs) after bariatric arterial embolization (BAE) using soluble gelatin sponge particles (SGSs) or tris-acryl gelatin microspheres (MSs) in swine. Twelve swine underwent embolization of gastric fundal arteries with SGSs (n = 4) or MSs (n = 4) or underwent saline infusion (n = 4, control group). One week later, the number of gastric ulcers and the percentage of GECs were compared among the 3 groups. There were no ulcers in the SGS and control groups. Two swine in the MS group had 4 large ulcers (12–50 mm in size). The mean percentages of GECs were significantly lower in the SGS (2.7% ± 0.9%) and MS (2.5% ± 1.0%) groups compared with the control group (3.7% ± 1.3%; P = .038 and P = .016, respectively). SGSs may be safer than MSs for BAE while inducing a similar reduction of GECs in swine.

Bariatric Arterial Embolization: Current Status

AbstractObesity is a well-known major public health concern that causes significant morbidity and mortality with severe effects on the healthcare system and its financial status. Classic treatment options for obesity include lifestyle interventions, pharmacotherapy, and bariatric surgery. However, there is a treatment gap for patients in whom lifestyle modifications were not sufficient or satisfactory, and yet bariatric surgery is not a suitable option. Bariatric artery embolization (BAE) is a novel, minimally invasive, image-guided endovascular procedure that induces weight loss by reducing the production of appetite-mediating hormones following transarterial embolization of the gastric fundus. Recent evidence has shown that BAE is safe and effective in inducing clinically significant weight. This article will review the existing preclinical and clinical evidence on BAE, and discuss the future directions for this procedure.

Abstract No. 49 Bariatric arterial embolization with radiopaque microspheres: the effect of embolic size and embolization coverage on the outcome

To evaluate the embolization effect of calibrated radiopaque microspheres on the safety and efficacy of bariatric arterial embolization (BAE) Twenty-four healthy growing swine were recruited in two cohorts. In the first cohort, 16 animals were randomized to receive either 40-90 μm-sized radiopaque microspheres in the left gastroepiploic artery (LGEA, n = 4), or in the right gastric artery (RGA) and LGEA (n = 4), or 100-300 μm-sized microspheres in the LGEA and RGA (n = 4), or saline (n = 4). In the second cohort, eight animals underwent BAE with tightly calibrated 100-200 μm radiopaque microspheres (n = 5) or saline (n = 3) in the LGEA and RGA. Animal weight and serum hormones were measured at baseline and weekly after BAE for up to 8 weeks. Cone-beam CT (CBCT) images of the stomachs were acquired immediately and at 8 weeks after embolization to assess the embolization coverage of the fundus and the persistence of the microspheres. Endoscopy of the stomach was performed at 1-2 weeks after BAE to examine mucosal integrity. Ghrelin-expressing cell densities were assessed by immunohistochemistry staining and analyzed using the Wilcoxon rank sum test. Plasma ghrelin levels were assessed using a radioimmunoassay. Radiopaque microspheres were visible both on fluoroscopy and CBCT images irrespective of the microsphere sizes. BAE with 40-90 μm and 100-300 μm microspheres resulted in severe gastric ulceration in embolized animals and no significant weight changes compared to controls. In contrast, BAE with 100-200 μm-sized microspheres induced mild gastric ulcerations and a significant reduction of weight gain relative to controls (42.3% ± 5.7 BAE vs 51.6% ± 2.9 controls at 8 weeks, P = 0.04). This weight reduction was correlated to greater fundal embolization coverage. Both fundal ghrelin-expressing cell densities (16.1 ± 6.7 BAE vs 23.6 ± 12.6 control, P = 0.045) and plasma ghrelin levels of (1709 ± 172 BAE vs 4343 ± 1555 controls, P < 0.01) BAE-treated animals were significantly lower than those of controls at 8 weeks. Radiopaque microspheres enable direct visualization of embolic material during and after embolization. The size and fundal embolization coverage of the microspheres affect the outcome of BAE. The calibrated 100-200 μm radiopaque microspheres appear to be safe and effective for weight management via BAE.

Bariatric Embolization in the Treatment of Patients with a Body Mass Index Between 30 and 39.9kg/m2 (Obesity Class I and II) and Metabolic Syndrome, a Pilot Study.

To evaluate the efficacyandclinical safetyof bariatric arterial embolization(BAE) inadults with body mass index (BMI) between 30 and 39.9kg/m2 and metabolic syndrome (MS). Between March and August 2018, ten female participants between 21 and 48-years-old,median BMIof36.37±2.58kg/m2 andMSwere enrolled in this prospective trial. We embolized the fundal branches from the left gastric and other artery sources, which resulted in embolization of at least two arteries in 9 out 10 participants. Six months after bariatric embolization, efficacywas assessedby changes in total body weight (TBW), ghrelin and HomeostaticModelAssessment-InsulinResistance (HOMA-IR) levelsand by changes inquality of life (QOL) andinbinge eatingscale (BES) scores. Safety was assessed by the identification of any related complications, including gastric ulcers, screened by gastrointestinal endoscopy, performed before and one week and one month after BAE. Six months after embolization, TBW decreased by 6.8% (6.22kg±3.6;p = .01), serum ghrelin dropped from 25.39pg/ml±10.63 to 17.1±8.07 (p = 0.01), and HOMA-IR decreased from7.29±5.66 to 3.73±1.99 (p = 0.01). The QOL scores improvedfrom 59.64±5.59 to 69.02±11.97 (p < 0.05) and in the BES from 21.50±8.89 to 9.60±4.40(p = 0.01). Endoscopy revealed symptomaticgastric ulcers in two participants, which had healed without sequelae. In one participant, ultrasound revealed an asymptomatic focal arterial thrombus at the left distal radial artery puncture site. BAE is effective in reducing weight, insulin resistance and ghrelin levels and improving BES and QOL scores in patients with class I and II obesity and MS,with no major complications.

Bariatric Arterial Embolization with Calibrated Radiopaque Microspheres and an Antireflux Catheter Suppresses Weight Gain and Appetite-Stimulating Hormones in Swine

PurposeTo examine safety and efficacy of bariatric arterial embolization (BAE) with x-ray–visible embolic microspheres (XEMs) and an antireflux catheter in swine. Material and MethodsBAE with selective infusion of XEMs (n = 6) or saline (n = 4, control) into gastric fundal arteries was performed under x-ray guidance. Weight and plasma hormone levels were measured at baseline and weekly for 4 weeks after embolization. Cone-beam CT images were acquired immediately after embolization and weekly for 4 weeks. Hormone-expressing cells in the stomach were assessed by immunohistochemical staining. ResultsBAE pigs lost weight 1 week after embolization followed by significantly impaired weight gain relative to control animals (14.3% vs 20.9% at 4 weeks, P = .03). Plasma ghrelin levels were significantly lower in BAE pigs than in control animals (1,221.6 pg/mL vs 1,706.2 pg/mL at 4 weeks, P < .01). XEMs were visible on x-ray and cone-beam CT during embolization, and radiopacity persisted over 4 weeks (165.5 HU at week 1 vs 158.5 HU at week 4, P = .9). Superficial mucosal ulcerations were noted in 1 of 6 BAE animals. Ghrelin-expressing cell counts were significantly lower in the gastric fundus (17.7 vs 36.8, P < .00001) and antrum (24.2 vs 46.3, P < .0001) of BAE pigs compared with control animals. Gastrin-expressing cell counts were markedly reduced in BAE pigs relative to control animals (98.5 vs 127.0, P < .02). Trichrome staining demonstrated significantly more fibrosis in BAE animals compared with control animals (13.8% vs 8.7%, P < .0001). ConclusionsXEMs enabled direct visualization of embolic material during and after embolization. BAE with XEMs and antireflux microcatheters was safe and effective.

Uneventful sleeve gastrectomy post bariatric arterial embolization

We present the case of a 42-year-old female patient who successfully and uneventfully underwent gastric sleeve surgery 3-years after left gastric artery embolization, for the treatment of obesity. This case highlights that left gastric artery embolization may not preclude future bariatric surgeries in this subset of patients who initially fail to lose weight after bariatric arterial embolization (BAE).

A Review of Past and Present Weight Loss Strategies and the Potential Role of Bariatric Arterial Embolization

AbstractThe obesity epidemic is a growing public health concern that has a severe effect on the health care system with significant morbidity, mortality, and cost. Treatment options for obesity include lifestyle modifications, pharmacotherapy, and bariatric surgery. Newer, less-invasive therapies including endoscopic bariatric procedures have been developed in recent years to fill the treatment gap that exists between noninvasive approaches and surgery. Bariatric artery embolization (BAE) is a novel minimally invasive endovascular procedure that has been developed to treat obesity. Recent evidence has suggested that bariatric embolization is well tolerated and can induce clinically significant weight loss through a hormonally mediated mechanism. This article will review existing preclinical and clinical data, and explore future directions of the endovascular treatment of obesity.

Abstract No. 688 Bariatric arterial embolization with radiopaque microspheres suppresses ghrelin expression and weight gain in swine

To evaluate the embolization effect of calibrated radiopaque microspheres on ghrelin production and weight change in a swine model. Eight healthy growing swine (∼23 kg) were randomized to receive either bariatric artery embolization (BAE) with 100-200 μm radiopaque microspheres (Boston Scientific) (n = 5) or saline (n = 3) in the left gastroepiploic artery and right gastric artery under x-ray guidance. Weight and fasting blood samples were obtained at baseline and weekly for 8 weeks. Cone beam CT (CBCT) images of the stomachs were acquired immediately after embolization, at 8 weeks prior to sacrifice and postmortem to examine the imaging visibility and persistence of the embolic microspheres. Biopsies of the fundus were taken during endoscopic examination at ∼1 week after embolization. Ulcers were scored from 0 to 3. Plasma ghrelin levels were assessed using a radioimmunoassay. The ghrelin-expressing cell densities in the stomach were assessed by immunohistochemical staining and analyzed using the Wilcoxon rank sum test. Radiopaque microspheres were visible on x-ray and CBCT during the procedure and the radiopacity persisted for 8 weeks after BAE. BAE pigs showed a significant reduction of the percentage of weight gain relative to controls (42.3% ± 5.7 vs. 51.6% ± 2.9, P = 0.04). The ghrelin-expressing cell densities of fundal biopsies were similar between embolized animals and controls. Yet, both fundal ghrelin-expressing cell densities (16.1 ± 6.7 vs. 23.6 ± 12.6, P = 0.04) and plasma ghrelin levels (1709 ± 172 vs. 4343 ± 1555, P <0.01) of embolized animals were significantly lower than those of controls at week 8. All BAE animals developed superficial ulcers (score 1: n = 4, score 2: n = 2) that healed by week 8 after embolization. Radiopaque microspheres enabled direct visualization of embolics delivery and deposition during and post embolization procedure. The suppression of fundal and systemic plasma ghrelin levels as well as the percentage of weight gain in combination with mild mucosal damage suggests that the calibrated 100-200 μm radiopaque microspheres may be the optimal embolics for effective weight management via BAE.

Bariatric Arterial Embolization: Position Statement by the Pan Arab Interventional Radiology and the Saudi Interventional Radiology Societies

Bariatric Arterial Embolization: Position Statement by the Pan Arab Interventional Radiology and the Saudi Interventional Radiology Societies

Bariatric Embolization of Arteries With Imaging Visible Embolics (BEATLES)

Bariatric Embolization of Arteries With Imaging Visible Embolics (BEATLES)

Bariatric Embolization of Arteries for the Treatment of Obesity (BEAT Obesity) Trial: Results at 1 Year.

Background Bariatric embolization is a new endovascular procedure to treat patients with obesity. However, the safety and efficacy of bariatric embolization are unknown. Purpose To evaluate the safety and efficacy of bariatric embolization in severely obese adults at up to 12 months after the procedure. Materials and Methods For this prospective study (NCT0216512 on ClinicalTrials.gov ), 20 participants (16 women) aged 27-68 years (mean ± standard deviation, 44 years ± 11) with mean body mass index of 45 ± 4.1 were enrolled at two institutions from June 2014 to February 2018. Transarterial embolization of the gastric fundus was performed using 300- to 500-µm embolic microspheres. Primary end points were 30-day adverse events and weight loss at up to 12 months. Secondary end points at up to 12 months included technical feasibility, health-related quality of life (Short Form-36 Health Survey ([SF-36]), impact of weight on quality of life (IWQOL-Lite), and hunger or appetite using a visual assessment scale. Analysis of outcomes was performed by using one-sample t tests and other exploratory statistics. Results Bariatric embolization was performed successfully for all participants with no major adverse events. Eight participants had a total of 11 minor adverse events. Mean excess weight loss was 8.2% (95% confidence interval [CI]: 6.3%, 10%; P < .001) at 1 month, 11.5% (95% CI: 8.7%, 14%; P < .001) at 3 months, 12.8% (95% CI: 8.3%, 17%; P < .001) at 6 months, and 11.5% (95% CI: 6.8%, 16%; P < .001) at 12 months. From baseline to 12 months, mean SF-36 scores increased (mental component summary, from 46 ± 11 to 50 ± 10, P = .44; physical component summary, from 46 ± 8.0 to 50 ± 9.3, P = .15) and mean IWQOL-Lite scores increased from 57 ± 18 to 77 ± 18 (P < .001). Hunger or appetite decreased for 4 weeks after embolization and increased thereafter, without reaching pre-embolization levels. Conclusion Bariatric embolization is well tolerated in severely obese adults, inducing appetite suppression and weight loss for up to 12 months. Published under a CC BY-NC-ND 4.0 license. Online supplemental material is available for this article.

03:45 PM Abstract No. 28 Histological sequelae of selective bariatric arterial embolization with radiopaque microspheres in swine

03:45 PM Abstract No. 28 Histological sequelae of selective bariatric arterial embolization with radiopaque microspheres in swine

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

Purpose To determine whether microsphere size effects ghrelin expression and weight gain after selective bariatric arterial embolization (BAE) in swine. Materials and Methods BAE was performed in 10 swine by using smaller (100-300 μm; n = 5) or larger (300-500 μm; n = 5) calibrated microspheres into gastric arteries. Nine control pigs underwent a sham procedure. Weight and fasting plasma ghrelin levels were measured at baseline and weekly for 16 weeks. Ghrelin-expressing cells (GECs) in the stomach were assessed by using immunohistochemical staining and analyzed by using the Wilcoxon rank-sum test. Results In pigs treated with smaller microspheres, mean weight gain at 16 weeks (106.9% ± 15.0) was less than in control pigs (131.9% ± 11.6) (P < .001). Mean GEC density was lower in the gastric fundus (14.8 ± 6.3 vs 25.0 ± 6.9, P < .001) and body (27.5 ± 12.3 vs 37.9 ± 11.8, P = .004) but was not significantly different in the gastric antrum (28.2 ± 16.3 vs 24.3 ± 11.6, P = .84) and duodenum (9.2 ± 3.8 vs 8.7 ± 2.9, P = .66) versus in control pigs. BAE with larger microspheres failed to suppress weight gain or GECs in any stomach part compared with results in control swine. Plasma ghrelin levels were similar between BAE pigs and control pigs, regardless of microsphere size. Week 1 endoscopic evaluation for gastric ulcers revealed none in control pigs, five ulcers in five pigs embolized by using smaller microspheres, and three ulcers in five pigs embolized by using larger microspheres. Conclusion In bariatric arterial embolization, smaller microspheres rather than larger microspheres showed greater weight gain suppression and fundal ghrelin expression with more gastric ulceration in a swine model. © RSNA, 2018.