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Bariatric embolization targets ghrelin for weight loss

NASHVILLE, Tenn. — Left gastric artery embolization — an interventional radiology procedure in which microparticles are introduced by catheter into the artery to partially block blood supply to the gastric fundus — is being explored in several small studies as a possible minimally invasive treatment for obesity, according to a speaker at ObesityWeek.

Mubin I. Syed

Although the mechanism of action has not been established, researchers are focusing on ghrelin, an appetite-stimulating hormone that acts on the hypothalamus and amygdala, according to Mubin I. Syed, MD, an interventional and neuroradiologist and president and co-owner of Dayton Interventional Radiology in Florida. Speaking during the Innovative and Emerging Pharmacotherapy and Devices Forum, Syed said 90% of ghrelin is produced in the gastric fundus, and production diminishes following certain weight-loss surgeries, such as gastric bypass.

“We believe the procedure is promising for appetite suppression, but at the same time obesity is multifactorial and people eat for reasons other than hunger, of course,” Syed said. “At this point the study is still early, and we can’t exclude surgical placebo effect.”

In a 2016 FDA investigational devices exemption study dubbed GET LEAN, Syed and colleagues performed left gastric artery embolization on five adults with a BMI of at least 40 kg/m2 and weight less than 400 lb (due to equipment size limitations); one participant had diabetes (baseline HbA1c, 7.4%). All participants had previously attempted weight loss through lifestyle without success.

Participants underwent esophagogastroduodenoscopy, CT angiography and a gastric emptying study before and after the procedure, and researchers measured ghrelin, leptin and cholecystokinin levels at baseline and after the procedure. All participants were prescribed a proton pump inhibitor for 7 days leading up to the procedure and continued after the procedure. Follow-up occurred at 3 days, 1 week, and 1, 3, 6 and 12 months.

At 6 months, the researchers observed a nonsignificant mean weight loss of 16.6 lb, which was 7% of total body weight and 13.7% of excess weight lost, according to Syed, and ghrelin decreased by 9.95%. In the participant with diabetes, HbA1c decreased to 6.3% at 3 months and 5.9% at 12 months.

“This has potential for major weight loss equal to surgery, but of course it’s too early to tell,” Syed said.

Researchers observed no major adverse events, but participants experienced superficial gastric ulcerations, which had healed at 30 days. Some also experienced mild nausea, vomiting and epigastric discomfort that resolved within 24 hours, which was anticipated, Syed said.

“The key caveat here is that gastric sleeve surgery may not be performed after bariatric embolization because the left gastric artery is the sole supply to the gastric remnant, so we counsel all patients beforehand that they have to tell us they’re not interested in surgery afterward,” Syed said.

Based on GET LEAN and other small studies, Syed said, left gastric artery embolization in conjunction with lifestyle modifications should be an option for adults with any level of overweight or obesity.

“The key thing is patient motivation,” Syed said. “This is one of the things we think may change at some level of copay or some financial interest in the procedure.” – by Jill Rollet

Reference:

Syed M, et al. Gastric artery embolization for the lessening of appetite nonsurgically (GET LEAN), 6-month results. Presented at: ObesityWeek 2018; Nov. 11-15, 2018; Nashville, Tenn.

Disclosure: Syed reports no relevant financial disclosures.

NASHVILLE, Tenn. — Left gastric artery embolization — an interventional radiology procedure in which microparticles are introduced by catheter into the artery to partially block blood supply to the gastric fundus — is being explored in several small studies as a possible minimally invasive treatment for obesity, according to a speaker at ObesityWeek.

Mubin I. Syed

Although the mechanism of action has not been established, researchers are focusing on ghrelin, an appetite-stimulating hormone that acts on the hypothalamus and amygdala, according to Mubin I. Syed, MD, an interventional and neuroradiologist and president and co-owner of Dayton Interventional Radiology in Florida. Speaking during the Innovative and Emerging Pharmacotherapy and Devices Forum, Syed said 90% of ghrelin is produced in the gastric fundus, and production diminishes following certain weight-loss surgeries, such as gastric bypass.

“We believe the procedure is promising for appetite suppression, but at the same time obesity is multifactorial and people eat for reasons other than hunger, of course,” Syed said. “At this point the study is still early, and we can’t exclude surgical placebo effect.”

In a 2016 FDA investigational devices exemption study dubbed GET LEAN, Syed and colleagues performed left gastric artery embolization on five adults with a BMI of at least 40 kg/m2 and weight less than 400 lb (due to equipment size limitations); one participant had diabetes (baseline HbA1c, 7.4%). All participants had previously attempted weight loss through lifestyle without success.

Participants underwent esophagogastroduodenoscopy, CT angiography and a gastric emptying study before and after the procedure, and researchers measured ghrelin, leptin and cholecystokinin levels at baseline and after the procedure. All participants were prescribed a proton pump inhibitor for 7 days leading up to the procedure and continued after the procedure. Follow-up occurred at 3 days, 1 week, and 1, 3, 6 and 12 months.

At 6 months, the researchers observed a nonsignificant mean weight loss of 16.6 lb, which was 7% of total body weight and 13.7% of excess weight lost, according to Syed, and ghrelin decreased by 9.95%. In the participant with diabetes, HbA1c decreased to 6.3% at 3 months and 5.9% at 12 months.

“This has potential for major weight loss equal to surgery, but of course it’s too early to tell,” Syed said.

Researchers observed no major adverse events, but participants experienced superficial gastric ulcerations, which had healed at 30 days. Some also experienced mild nausea, vomiting and epigastric discomfort that resolved within 24 hours, which was anticipated, Syed said.

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“The key caveat here is that gastric sleeve surgery may not be performed after bariatric embolization because the left gastric artery is the sole supply to the gastric remnant, so we counsel all patients beforehand that they have to tell us they’re not interested in surgery afterward,” Syed said.

Based on GET LEAN and other small studies, Syed said, left gastric artery embolization in conjunction with lifestyle modifications should be an option for adults with any level of overweight or obesity.

“The key thing is patient motivation,” Syed said. “This is one of the things we think may change at some level of copay or some financial interest in the procedure.” – by Jill Rollet

Reference:

Syed M, et al. Gastric artery embolization for the lessening of appetite nonsurgically (GET LEAN), 6-month results. Presented at: ObesityWeek 2018; Nov. 11-15, 2018; Nashville, Tenn.

Disclosure: Syed reports no relevant financial disclosures.

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