Left Gastric Artery Embolization Research Articles

Adding Short to Left Gastric Artery Embolization for the Treatment of Obesity: Safety and Effectiveness.

This study assessed the safety and effectiveness of a technical modification that involves adding short gastric artery (SGA) embolization to left gastric artery (LGA) embolization. This retrospective single-center study analyzed twenty obese patients (median age of 53.5 (30-73)) who were not eligible for bariatric surgery and underwent bariatric embolization with 300-500-µm microspheres in addition to a lifestyle counseling program between March 2021 and July 2022. Eight patients had LGA + SGA embolization, and twelve had LGA embolization alone. The primary outcome measure was total body weight loss (TBWL) at 6months in the SGA + LGA and the LGA-only cohorts. Safety was assessed, defined as the 30-day adverse events rate according to the SIR classification. The mean 6-month post-embolization TBWL in the SGA + LGA cohort was 7.3kg (95%CI 2.1-12.4; p = .01) and 4.1kg (95%CI 0.4-8.6; p = 0.034) in the LGA-only cohort (mean difference - 3.1kg ± 2.8; 95%CI (- 9.1-2.8); p = .28). The mean 6-month post-embolization TBWL in the entire cohort was 5.3kg (p < .01). The rate of complications was similar between the two groups. Combined SGA and LGA embolization is safe and effective to treat obesity. Larger studies are needed to determine whether SGA + LGA embolization results in more significant weight loss than LGA embolization alone.

Nové perspektivy v bariatricko-metabolické léčbě

Summary: Obesity is a chronic disease that affects millions of people worldwide and is associated with many health complications. The main goal of obesity treatment is to improve health by achieving and maintaining weight loss or through imposing metabolic changes. For treatment, there are several interventions available, such as diet and exercise, drug therapy, surgical procedures. If used as MONO therapy, they often show insufficiency to achieve/maintain adequate weight loss and/or metabolic improvement in long term. Patients seeking low invasive, however still efficient treatment or those with insufficient treatment results or side effects may, under view of new developments both in pharma and surgery, benefit from combined approach of both, anti-obesity medications and very low invasive bariatric-metabolic surgery, such as gastric plication (namely endoscopic plication), partial jejuno-ileal diversion and left gastric artery embolization. There are several new anti-obesity drugs that have been developed or are in development. These drugs target different pathways in the body, such as hormones, neurotransmitters, receptors, enzymes, i.e. to reduce food intake, increase energy expenditure, alter nutrient absorption. In bariatric-metabolic surgery new understanding of the mechanisms of action, which involve not only mechanical restriction or malabsorption, but also neurohormonal modulation, gut microbiome alteration, immune system regulation, and epigenetic changes is being applied to the treatment pathways. For optimal success, heterogeneity of treatment response needs to be incorporated into management plans. Low invasive bariatric-metabolic surgery combined with pharmacotherapy can lead to additive weight-loss benefits and less side effects and it usually works in synergy with medications. Thus, combined approach to obesity treatment that involves anti-obesity medications and BMS are complementary to each other. Laparoscopic PJID seems to be one of the promising non-drug interventions, especially for type 2 diabetic patients with poorly controlled diabetes. Pilot results at two, five and seven years are presented in the article. In 5 years after PJID mean BMI decreased by –12.4%. Mean HbA1c decreased in 2 years after the operation by mean of –2.48 (–32.3%), after 5 years by –3,51 (–45.8%) and in 7 years still decrease of –2.39 (–31.2%) was noted. Glycaemia decreased by mean of –2.5 mmol/l in 2 years, in 5 years postoperatively mean decrease was –4.8 (–44.0%) a in 7 years the mean decrease was – 5.5 mmol/l (–50.4%) in comparison with the pre-op values. Partial jejunal diversion provides an anatomy sparing, low risk, potentially reversible, metabolic procedure, especially in a view of potential use of magnetic approach. The operation does not neccessitate significant alterations in lifestyle, mineral and/or vitamin supplementation and offers rapid recovery. Anti-obesity medications may help prepare patients for bariatric surgery by inducing preoperative weight loss and reducing surgical risk and/or through leveraging treatment outcomes if used in the immediate postoperative period. May also help to prevent or treat weight regain after bariatric surgery by enhancing satiety and reducing hunger. In non-responders to medication before they get surgery may trigger respond to the medication after surgery. New obesity treatment model that utilizes combination of new drugs and low invasive treatment (such as surgical, endoscopic and other new technologies, e.i.magnetic surgery), can enhance and leverage treatment outcomes without increasing risks. Key words: obesity – bariatric-metabolic surgery – pharmacotherapy – combined treatment

Morphological changes in the abdominal organs after left gastric artery embolization in an experiment

Objective – to experimentally evaluate the morphological changes of internal organs (liver, spleen, duodenum, pancreas) after embolization of gastric arteries.Material and methods. To conduct the experiment, 10 Vietnamese pigs aged 4-5 months, female, were selected and fed a high-fat diet for 2 months to simulate obesity. Aorta contrast and celiacography with "Vazipak" solution (5-10 ml per injection) were performed on animals under general anesthesia. Superselective bariatric embolization of the left gastric artery was performed with a 3F microcatheter. After 3 weeks, a morphological (hematoxylin-eosin staining) examination of such organs as liver, duodenum, spleen, pancreas was performed. Photofixation of the histopreparations of the relevant organs was carried out using a trinocular microscope of laboratory class Nikon Eclipse Ci-E with 10x, 20x and 40x plan achromat objectives.Results. In general, no macroscopic signs of ischemia of adjacent organs were noted against the background of the performed selective embolization of the left gastric artery. Blood filling of the liver was uneven, the perisinusoidal spaces were expanded, which indicated its edema. In the duodenum, reactive disturbances of microcirculation were manifested by expansion and congestion of venous vessels and blood stasis. Microscopic changes in the spleen were characterized by congestion of the sinusoids, while the vessels of the pancreas were unevenly filled with blood, and at the same time, venous congestion prevailed.Conclusion. Microcirculation disorders, dystrophic changes, and signs of a shock reaction, which can be considered transient, occur in the examined organs after embolization of the gastric arteries. These data indicate the safety of performing selective embolization of gastric arteries and the absence of signs of critical redistribution of blood flow or ischemia "robbing".

Treatment of obesity with type 2 diabetes mellitus by trans-catheter left gastric artery embolization under the thermo-sensitive nano-gel vascular embolization agent

Treatment of obesity with type 2 diabetes mellitus by trans-catheter left gastric artery embolization under the thermo-sensitive nano-gel vascular embolization agent

S2645 Remnant Stomach Bleeding in Roux-en-Y Gastric Bypass Anatomy Managed by Transgastric Endoscopic Ultrasound-Guided Stenting and Hemostasis

Introduction: Upper GI bleeding identification and treatment is challenging in patients with Roux-en-Y gastric bypass (RYGB) due to their complex anatomy. Remnant stomach and duodenal bleeding in particular can be very challenging to reach and manage endoscopically due to the long length of the Roux and biliary limb. Case Description/Methods: A 58-year-old female patient, who underwent gastric bypass in 2004, was diagnosed with fibular fracture and placed on NSAIDs 2 weeks before presenting to the hospital with melena and anemia. In addition to medical management of hypovolemic shock, the patient underwent upper endoscopy (EGD), colonoscopy, small bowel enteroscopy, and angiography followed by left gastric artery embolization all of which failed to localize or stop her bleeding. The patient’s hemoglobin dropped to a nadir of 5.7, and she was referred for upper endoscopic ultrasound which demonstrated a very large clot burden within the excluded stomach ( Figurea), and an ultrasound-guided gastrogastric lumen apposing metal stent (LAMS) was placed from the gastric pouch into the excluded stomach. The stent was successfully dilated and fixed with stay sutures (Figure1b). A large burden of clot was subsequently removed from the excluded stomach and duodenum. A deep ulcer with active bleeding was localized to the posterior wall of the duodenum. Bipolar cautery and epinephrine injection were used initially but failed to achieve hemostasis. Over-the-scope clip was considered but given the lack of having a mature gastrogastric fistula tract it was instead elected to use hemostatic powder application ( Figurec). With this, complete hemostasis was achieved, and the LAMS stent was left in place for subsequent intervention(s) as needed. The patient continued to pass melena for 3 days post procedure with stable Hb readings and follow up EGD showed no signs of active bleeding in the excluded stomach or duodenum. At 6 weeks, the LAMS was removed and the gastrogastric fistula tract was closed with argon plasma resurfacing and suture. Discussion: Identification the source of UGIB in RYGB patients can be challenging. Accessing the excluded stomach should be considered early in the evaluation if the EGD shows no obvious source of bleeding or if other evaluation (such as angiogram) suggests a remnant stomach or duodenal source.Figure 1.: (1a) Endosonographic photo showing blood in the remnant stomach, (1b) Fluoroscopy showing proper placement and dilatation of the gastrogastric LAMS , (1c) Endoscopic photo showing complete hemostasis after hemostatic powder application.

S2576 Application of Hemospray for Metastatic Bleeding Gastric Adenocarcinoma: A Case Report

Introduction: TC-325 hemostatic powder (Hemospray) is a mineral-based topical agent that acts as a mechanical barrier over a bleeding site. It is a non-invasive, safe, and effective modality in controlling active GI bleeding, with immediate response. Here, we present a case of bleeding metastatic gastric adenocarcinoma managed with Hemospray after the failure of standard endoscopic therapy. Case Description/Methods: A 64-year-old male presented to the emergency room (ER) for symptomatic anemia. His hemoglobin was 4.6 g/dL. CT imaging showed gastric cardia lesion with multiple hepatic metastases. After blood transfusion, EGD (Figure 1a) showed a cardia lesion with oozing blood from multiple sites. Endoscopic ultrasound with fine-needle aspiration, showing atypical cells. The patient continued to have melena requiring transfusions. CT angiogram was negative. Partial gastrectomy was not performed due to peritoneal carcinomatosis. Endoscopic hemostasis with epinephrine and clips failed (Figure 1b). Hemospray was deployed (Figure 1c) with an immediate response. Later patient underwent left gastric artery embolization (Figure 1d), liver biopsy and peritoneal node sampling that suggested metastatic adenocarcinoma with primary gastric malignancy. The patient and his family opted for palliative care and was discharged. Discussion: Gastric cancer accounts for 2-8% of overall UGIB and 58% bleeding risk compared to other GI malignancies. There are no specific guidelines and only limited evidence was available on managing malignancy-related UGIB. Nonresponsive, inoperable metastatic gastric cancer bleeding is challenging and extremely difficult to manage using conventional hemostasis techniques. Based on our case, we recommend utilizing Hemospray as a first-line, monotherapy or in combination to control bleeding until a definitive treatment, reducing morbidity and mortality.Figure 1.: (A) Submucosal gastric fundal mass distal to gastroesophageal junction with blood oozing from multiple sites (arrows), (B) Image showing endoscopic hemostatic clips placement (arrowheads), (C) Application of Hemospray over the Gastric Mass after unsuccessful attempts using standard-of-care hemostatic methods, (D) Showing embolization of the left gastroepiploic artery.

Metabolic outcomes of left gastric artery embolization in obese patients (a pilot study)

Rationale: According to the published data, bariatric procedure of left gastric artery embolization (LGAE) as one of the minimally invasive and innovative methods for obesity treatment promotes reductions in bodyweight and ghrelin levels.Aim: To evaluate the effect of LGAE on the parameters of fat and carbohydrate metabolism in obese patients.Materials and methods: Twenty three (23) patients (10 male and 13 female, mean age 40.2 ± 10.6 years) with morbid obesity (body mass index [BMI] &gt; 40 kg/m2) and obesity grade 2 (BMI &gt; 35 kg/m2) underwent a minimally invasive procedure in the form of bariatric embolization of the left gastric artery with polyvinyl alcohol particles of 500 to 700 mcm in diameter. We compared anthropometric parameters (height in cm, body-weight in kg, BMI in kg/m2, waist circumference in cm) at baseline and at 6 months after LGAE. Laboratory examinations included measurements of plasma adiponectin, ghrelin, leptin, fasting glucose, HbA1c, insulin, and HOMA-IR (insulin resistance index).Results: At 6 month after LGAE, the patients' bodyweight decreased from 138.1 ± 33.2 kg to 113 ± 26 kg (p &lt; 0.01) (by 18.2%), BMI from 47.4 ± 9.3 kg/m2 to 38.1 ± 7.4 kg/m2 (p &lt; 0.01) (by 19.6%), waist circumference from 130.4 ± 9.7 cm to 115 ± 10.3 cm (p &lt; 0.01) (by 11.8%). Mean adiponectin levels increased significantly from 22.5 ± 8.1 μg/ml before LGAE to 42.4 ± 11 μg/ml at 6 months (p &lt; 0.001) (by 88.4%). Baseline ghrelin levels of 20.23 ± 4.8 femtomol/μL decreased to 2.09 ± 0.6 femtomol/μL at 6 months (p &lt; 0.001) (by 89.6%). Mean leptin levels were 23.3 ± 4.9 ng/ml and 10.5 ± 3.7 ng/ml at baseline and at 6 months, respectively (p &lt; 0.001) (by 54.9%). At 6 months after LGAE, there was a positive and significant trends in the parameters of carbohydrate metabolism: fasting glucose decreased from 6.9 ± 1.5 mmol/L to 5.1 ± 0.9 mmol/L (p &lt; 0.001) (by 26%), HbA1c from 6.2 ± 1% to 5.3 ± 0.6% (p &lt; 0.01) (by 14.5%), insulin from 15.6 ± 7.7 μU/ml to 8.1 ± 0.7 μU/ml (p &lt; 0.001) (by 48%), and the HOMA-IR index from 4.5 ± 1.2 to 1.9 ± 0.32 (p &lt; 0.001) (by 57.7%).Conclusion: At 6 months after LGAE, the patients with obesity grades 2 and 3 have demonstrated a reduction in bodyweight of 18–19%, with a decrease in the levels of leptin (the obesity hormone), ghrelin (hunger inducing hormone), and an increase in adiponectin levels, which is a marker of metabolic health. The patients also achieved their individual glycemic goals with a decrease in fasting glucose, insulin, glycated hemoglobin, and demonstrated an improvement in HOMA-IR.

Left gastric artery embolization for obesity treatment: a systematic review and meta-analysis of human and animal studies.

The main purpose of this systematic review was to reflect on recent literature on bariatric LGA embolization for obesity treatment and to compare this new procedure in human and animal studies. A systematic search of Scopus, MEDLINE, Web of Science, Embase, and Google Scholar was performed to identify human and animal studies employing bariatric LGA embolization to treat obesity. As well, Cochrane's Q test and the I2 statistic were utilized to determine heterogeneity. Nine human and four animal studies recruiting a total of 118 cases (n = 78 patients and n = 40 animals) were included in analysis. All assessments on body mass index (BMI), weight, and ghrelin levels had been fulfilled based on before-after (human studies) and intervention-control designs (animal studies) using bariatric LGA embolization. The findings suggested that bariatric LGA embolization had significantly decreased BMI (mean difference (MD): - 2.66, 95% confidence interval [CI] - 3.74, - 1.58, P < 0.001) and weight (MD: - 8.69, 95% CI - 10.48, - 6.89, P < 0.001) in humans. Although overall pooled estimate showed no significant changes in ghrelin levels following this procedure (Hedges' g statistic: - 0.91, 95% CI - 1.83, 0.01, P = 0.05) in humans, a significant reduction was observed in animal studies (MD: - 756.56, 95% CI - 1098.79, - 414.33, P < 0.001) along with a significant drop in weight (MD: - 7.64, 95% CI - 13.73, - 1.54, P < 0.001). The present study concluded that ghrelin levels in humans had not been affected, although bariatric LGA embolization might significantly improve BMI and weight.

Society of Interventional Radiology Quality Improvement Standards for Percutaneous Transcatheter Embolization

Percutaneous embolization procedures are commonly performed by interventional radiologists. This quality improvement (QI) standard was first published in 2010 (1), and this document represents the second update. Since the 2010 standards, many additional randomized controlled trials, meta-analyses, and observational studies have been published on transcatheter embolization for various disease entities, further establishing embolization as an effective treatment. Additionally, the indications of embolization have expanded with newer procedures, like prostatic embolization for benign prostatic hyperplasia (BPH), and emerging procedures, such as left gastric artery embolization for the treatment of obesity and genicular artery embolization for the treatment of pain related to osteoarthritis (OA).

A Novel Technique to Improve Anastomotic Perfusion Prior to Esophageal Surgery: Hybrid Ischemic Preconditioning of the Stomach. Preclinical Efficacy Proof in a Porcine Survival Model.

Simple SummaryEsophagectomy has a high rate of anastomotic complications thought to be caused by poor perfusion of the gastric graft, which is used to restore the continuity of the gastrointestinal tract. Ischemic gastric preconditioning (IGP), performed by partially destroying preoperatively the gastric vessels either by means of interventional radiology or surgically, might improve the gastric conduit perfusion. Both approaches have downsides. The timing, extent and mechanism of IGP remain unclear. A novel hybrid IGP method combining the advantages of the endovascular and surgical approach was introduced in this study. IGP improves unequivocally the mucosal and serosal blood-flow at the gastric conduit fundus by triggering new vessels formation. The proposed timing and extent of IGP were efficacious and might be easily applied to humans. This novel minimally invasive IGP technique might reduce the anastomotic leak rate of patients undergoing esophagectomy, thus improving their overall oncological outcome.Esophagectomy often presents anastomotic leaks (AL), due to tenuous perfusion of gastric conduit fundus (GCF). Hybrid (endovascular/surgical) ischemic gastric preconditioning (IGP), might improve GCF perfusion. Sixteen pigs undergoing IGP were randomized: (1) Max-IGP (n = 6): embolization of left gastric artery (LGA), right gastric artery (RGA), left gastroepiploic artery (LGEA), and laparoscopic division (LapD) of short gastric arteries (SGA); (2) Min-IGP (n = 5): LGA-embolization, SGA-LapD; (3) Sham (n = 5): angiography, laparoscopy. At day 21 gastric tubulation occurred and GCF perfusion was assessed as: (A) Serosal-tissue-oxygenation (StO2) by hyperspectral-imaging; (B) Serosal time-to-peak (TTP) by fluorescence-imaging; (C) Mucosal functional-capillary-density-area (FCD-A) index by confocal-laser-endomicroscopy. Local capillary lactates (LCL) were sampled. Neovascularization was assessed (histology/immunohistochemistry). Sham presented lower StO2 and FCD-A index (41 ± 10.6%; 0.03 ± 0.03 respectively) than min-IGP (66.2 ± 10.2%, p-value = 0.004; 0.22 ± 0.02, p-value < 0.0001 respectively) and max-IGP (63.8 ± 9.4%, p-value = 0.006; 0.2 ± 0.02, p-value < 0.0001 respectively). Sham had higher LCL (9.6 ± 4.8 mL/mol) than min-IGP (4 ± 3.1, p-value = 0.04) and max-IGP (3.4 ± 1.5, p-value = 0.02). For StO2, FCD-A, LCL, max- and min-IGP did not differ. Sham had higher TTP (24.4 ± 4.9 s) than max-IGP (10 ± 1.5 s, p-value = 0.0008) and min-IGP (14 ± 1.7 s, non-significant). Max- and min-IGP did not differ. Neovascularization was confirmed in both IGP groups. Hybrid IGP improves GCF perfusion, potentially reducing post-esophagectomy AL.

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).

Future of Bariatric Embolization: A Review of Up-to-date Clinical Trials.

Obesity is a significant health issue with an overall rise in mortality; it has multiple risk factors, including hormonal effects, which play a significant role in the balance of food intake and weight gain. Ghrelin is an anabolic hormone secreted from stomach fundus and plays a significant role in this regulation. Management of obesity involves multiple interventions, including lifestyle adjustment, pharmacotherapy, and bariatric surgery. Bariatric embolization is a relatively new procedure; several animal studies show that embolization of the left gastric artery reduces serum ghrelin and induces weight loss. Also, several clinical studies were conducted in the past ten years which have shown bariatric embolization's effectiveness in inducing weight loss: a meta-analysis of 47 patients included in six different clinical studies of left gastric artery embolization resulted in 8% total weight loss from baseline body weight. Many studies also show this procedure's effect on lowering the HgA1C level and lipid profile. Clinical studies mostly reported minor adverse effects such as transient abdominal discomfort, nausea and vomiting, gastric ulcers, and major adverse effects were uncommon, suggesting the procedure is well tolerated. It may be an alternative line of management in patients who are not suitable candidates for bariatric surgery.Although future clinical studies will provide an answer to several questions like the exact effects of the procedure on diabetes and metabolic syndrome, future studies are also needed to establish particular guidelines to match different patient characteristics with their optimal procedural techniques and pre- and post-procedure evaluation tests.

Left Gastric Artery Embolization for Weight Loss

Abstract Purpose To conduct a prospective clinical trial to evaluate the feasibility, safety and efficacy of left gastric artery embolization as a minimally-invasive way for the treatment of obesity. Materials &amp; Methods Patients were recruited with respect to detailed inclusion and exclusion criteria. A baseline clinical history taking and physical examination including anthropometric measurements was undertaken. A baseline EGD was performed to rule out any pre-existing pathology in the esophagus, stomach or duodenum. Baseline serum Ghrelin level was assessed. Embolization was performed using non-spherical polyvinyl alcohol particles sized 355–500 µm (Bearing nsPVA®, Merit Medical) until complete stasis of flow within the LGA and its branches. Patients were followed up weekly for 1 month then monthly for 6 months by anthropometric measurements by the clinical nutritionists from the Physical Medicine department. At 1 month, EGD was repeated to assess for any complications or adverse effects. Another blood sample was withdrawn to assess the change in serum Ghrelin level. Results Left gastric artery embolization was performed on six obese to morbidly obese patients (four women and two men; average age, 44 years; range, 24–62 years), with a mean weight of 113.67 kg (range 86–133 kg), a mean BMI of 44.45 kg/m2 (range 33.6–51.2 kg/m2) Technical success rate was 100%. There was one minor adverse event in the form of a small asymptomatic superficial gastritis in the fundus/lesser curvature. There were no major adverse events. Mean excess weight loss of 5.58% and 2.91% was noted at 1 month and at 6 months, respectively. Mean change in serum ghrelin was −35.57% at 1 month. Conclusion LGA embolization is technically feasible and safe. There is considerable drop in serum ghrelin level at 1 month. However, the weight loss appears to be transient. Future studies can opt for smaller-sized particles and probably embolization of the right gastro-epiploic artery together with the left gastric artery. Abbreviations BMI = Body Mass Index, EGD = Esophagogastroduodenoscopy, LGA = Left Gastric Artery, NSAID = Non-steroidal anti-inflammatory drugs, PPI = Proton pump inhibitors, WHO = World Health Organization.

Метаболические исходы у пациентов с ожирением после проведения бариатрической эмболизации левой желудочной артерии

Метаболические исходы у пациентов с ожирением после проведения бариатрической эмболизации левой желудочной артерии

Endoscopic hemostasis followed by preventive transarterial embolization in high-risk patients with bleeding peptic ulcer: 5-year experience

BackgroundUpper gastrointestinal bleeding (UGIB) due to peptic ulcer disease is one of the leading causes of death in patients with non-variceal bleeding, resulting in up to 10% mortality rate, and the patient group at high risk of rebleeding (Forrest IA, IB, and IIA) often requires additional therapy after endoscopic hemostasis. Preventive transarterial embolization (P-TAE) after endoscopic hemostasis was introduced in our institution in 2014. The aim of the study is an assessment of the intermediate results of P-TAE following primary endoscopic hemostasis in patients with serious comorbid conditions and high risk of rebleeding.MethodsDuring the period from 2014 to 2018, a total of 399 patients referred to our institution with a bleeding peptic ulcer, classified as type Forrest IA, IB, or IIA with the Rockall score ≥ 5, after endoscopic hemostasis was prospectively included in two groups—P-TAE group and control group, where endoscopy alone (EA) was performed. The P-TAE patients underwent flow-reducing left gastric artery or gastroduodenal artery embolization according to the ulcer type. The rebleeding rate, complications, frequency of surgical interventions, transfused packed red blood cells (PRBC), amount of fresh frozen plasma (FFP), and mortality rate were analyzed.ResultsFrom 738 patients with a bleeding peptic ulcer, 399 were at high risk for rebleeding after endoscopic hemostasis. From this cohort, 58 patients underwent P-TAE, and 341 were allocated to the EA. A significantly lower rebleeding rate was observed in the P-TAE group, 3.4% vs. 16.2% in the EA group; p = 0.005. The need for surgical intervention reached 10.3% vs. 20.6% in the P-TAE and EA groups accordingly; p = 0.065. Patients that underwent P-TAE required less FFP, 1.3 unit vs. 2.6 units in EA; p = 0.0001. The mortality rate was similar in groups with a tendency to decrease in the P-TAE group, 5.7% vs. 8.5% in EA; p = 0.417.ConclusionP-TAE is a feasible and safe procedure, and it may reduce the rebleeding rate and the need for surgical intervention in patients with a bleeding peptic ulcer when the rebleeding risk remains high after primary endoscopic hemostasis.

Weight Loss after Left Gastric Artery Embolization: A Systematic Review and Meta-Analysis.

A systematic review of clinical trials investigating the safety and efficacy of left gastric artery (LGA) embolization as a bariatric procedure was performed. The Methodological Index for Nonrandomized Studies (MINORS) instrument was used for quality assessment. Patient characteristics, weight loss after embolization, and complications were reviewed. Meta-regression was performed to assess associations of age, sex, body mass index, and ghrelin and leptin levels with weight change after LGA embolization. The final meta-analysis included 6 nonrandomized prospective trials. Findings of 3 additional studies reporting weight changes after LGA embolization for control of gastrointestinal bleeding were also reviewed. Pooled analysis of 47 subjects with overweight/obesity showed mean ± SD weight loss after embolization of 8.1% ± 1.5% and 8.85 kg ± 1.24 kg (both P < .001) after a mean 12-month follow-up. Male sex (β= 11.36 ± 5.79, P= .049) was associated with greater weight loss. Transient superficial mucosal ulcers were common after LGA embolization. One major adverse event comprising severe pancreatitis, splenic infarct, and gastric perforation was reported; treatment was supportive care. LGA embolization was associated with statistically significant weight loss and limited complications during short-term follow-up. Given that LGA embolization is an investigative method, it is important for researchers to follow standardized protocols and techniques to avoid complications.

Left Gastric Artery Embolization in Obese, Prediabetic Patients: A Pilot Study

PurposeTo evaluate the effect of left gastric artery embolization (LGAE) on glycated hemoglobin (HbA1c) in a prospective obese, prediabetic cohort. Materials and MethodsThis prospective pilot study included 10 obese, prediabetic patients (7 females and 3 males; mean age 37.5 ± 8.8 years; range 28–51 years) admitted to the Interventional Radiology Unit between January 2017 and June 2018 for LGAE for weight reduction. The main inclusion criteria were body mass index (BMI) >30 kg/m2 and HbA1c ranging from 5.7 to 6.4. Body weight, BMI, and HbA1c were assessed for each patient preprocedure and at 6 months postprocedure. Statistical analysis was performed using a paired sample t test. ResultsThe baseline mean body weight, BMI, and HbA1c were 107.4 ± 12.8 kg, 37.4 ± 3.3 kg/m2, and 6 ± 0.2, respectively. Concerning complications, no serious adverse events were detected. Six months after the procedure, the mean body weight and BMI significantly decreased to 98 ± 11.6 kg and 34.1 ± 3 kg/m2, respectively (P < .0001). A paired sample t test showed a significant reduction in HbA1c from pre- to postprocedure (6.1 ± 0.2 preprocedure vs 4.7 ± 0.6 postprocedure, P < .0001). The mean percent reductions in body weight, BMI, and HbA1c were 8.9% ± 1.2, 8.8% ± 1, and 21.4% ± 8.9, respectively. A statistically significant positive correlation was found between BMI and HbA1c after the procedure (r = 0.91, P = .0002). ConclusionsLGAE is well tolerated and leads to clinically significant decreases in weight and HbA1c in obese, prediabetic patients.

Radial Approach for Left Gastric Artery Angiography and Embolization for the Treatment of Obesity: Technical Considerations.

Bariatric embolization of the left gastric artery (LGA) is being investigated as a technique to induce substantial weight loss in obese patients. Radial access is associated with less vascular complications than femoral access, especially in patients with severe obesity. We sought to assess the feasibility, safety and technical challenges of LGA angiography through radial access. Patients with suspected coronary artery disease (CAD) and obesity (BMI > 30 kg/m2) referred for diagnostic catheterization and/or percutaneous coronary intervention (PCI) were eligible. After completion of diagnostic and/or PCI, selective cannulation of celiac artery was performed and images of the LGA were taken from multiple views. Detailed procedural parameters such as procedure time, contrast volume and radiation data as well as anatomical variations were assessed. Between February and December 2018, we successfully achieved 50 selective angiographies of celiac artery from 54 enrolled patients (92.6%) and LGA was optimally visualized in 47/50 (97%) of cases. Right radial access was used in 50 cases. Mean age was 63.9 ± 8.0 years and 74% were men. Median BMI was 34.4 kg/m2 [32.2-39.4]. The median procedural time was 7 [5-10] minutes, contrast volume was 41 ml [33-63], fluoroscopy time was 160 [103-248] seconds and radiation exposure was 3125 [1906-4735] Gy.cm2. No complications were noted. The mean difficulty of the procedure on a visual analogue scale was 4/10. LGA angiography via transradial approach was feasible in the large majority of CAD patients with obesity. No safety issues were encountered.

Body composition changes after left gastric artery embolization in overweight and obese individuals.

To determine the effects of left gastric artery embolization (LGAE) on computed tomography (CT) body composition change. Sixteen overweight or obese patients who had abdominal CT scans before and after LGAE for gastric bleeding were retrospectively reviewed. Body composition analysis was performed with semiautomated imaging processing algorithms (MATLAB 13.0, Math Works, MA). Adipose tissue and lean skeletal muscle were measured using threshold attenuation values. Total body fat index (BFI), subcutaneous fat index (SFI), visceral fat index (VFI), intramuscular fat index (IMFI), and skeletal muscle index (SMI) were determined ([tissue area (cm)]2/[height (m)]2). Excess body weight (EBW) was determined based on the Lorentz formula for ideal body weight. Mean follow-up was 1.5 ± 0.8months. Following LGAE, patients experienced significantly decreased body weight (p = 0.003), BMI (p = 0.005), EBW (p = 0.003), BFI (p = 0.03), SFI (p = 0.03), and SMI (p < 0.001). Changes in VFI and IMFI did not significantly change (p = 0.13 and p = 0.83, respectively). Patients who underwent LGAE had significant unintended weight loss as a result of decreased body fat and skeletal muscle. Body composition analysis can readily assess the extent of fat loss and identify muscle wasting.

03:18 PM Abstract No. 337 Transcatheter embolization for upper GI bleed: outcomes of empiric vs. selective embolization

To compare clinical outcomes between empiric embolization for angiographically occult upper GI bleed with selective embolization for angiographically detectable upper GI bleed. This IRB-exempt retrospective study reviewed 47 patients who underwent gastroduodenal artery (GDA) and left gastric artery (LGA) embolization for acute upper GI bleed at our institution between June 2009 to April 2017. 22 patients underwent prophylactic embolization while 25 patients underwent selective embolization. Demographics, smoking history, alcohol use, ICU needs, 30-day mortality rates, endoscopic interventions, major IR complication rates, rebleed rates and transfusion requirements were compared between groups using student T test and Chi-square test. There were significant gender differences between the empiric embolization group (14% females) and the selective embolization group (48% females, p=.014). There was no significant difference in age distribution, smoking history, or past and current alcohol use between the two groups. There were no differences in major IR complication rates after embolization. In the empiric embolization group, ICU needs (86% vs. 44%, p=.003) were greater. The empiric embolization group had greater rebleeding rate (41% vs. 12%, p=.024) and had higher proportion of cases requiring greater than 5 units of PRBC after embolization (32% vs. 0%, p=.002). However, there were no significant differences in need for endoscopic intervention post embolization (14% vs. 8%, p=.5). There were no significant differences in 30 day mortality rates (22.7% vs. 20%, p=.82). Selective embolization is more clinically effective for cessation of upper GI bleeding when compared to empiric embolization of the GDA and LGA with less rebleeding rates and transfusion requirements. However, the difference in 30 day mortality rates and the need for endoscopic intervention post embolization between the two groups are insignificant.