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Friday, April 3, 2015

Bariatric Embolization for the Treatment of Obesity: A Review

Bariatric embolization has been discussed as a possible treatment for obesity since first early pre-clinical studies were done by Arepally et al in 2007. While much work in this field has been done, there remain many challenges prior to full clinical implementation. The current state of BAE was recently reviewed in JVIR by researchers from Johns Hopkins. Weiss et al. provide a thorough review of the physiologic and anatomic basis along with a review of the preclinical and clinical data. If successful, BAE will represent a minimally invasive solution to obesity offered by interventional radiologists.

This manuscript does an excellent job reviewing the topic of BAE. The physiologic and anatomic basis for the procedure along with the current preclinical and clinical data are reviewed well. Clearly there are many challenges to mainstream implementation of this procedure. Many questions remain unanswered. What is the ideal embolic agent? What is the long-term outcome and will this procedure result in sustained weight loss? What is the best method of targeting the appropriate vascular bed? As more robust clinical trials provide answers to these questions, we will be closer to understanding the role this procedure may have in the treatment of this prevalent disease process.

Click here to see the full abstract

Angiogram of the left gastric artery. Fundal (solid arrows) and esophageal (dashed arrow) branches are identified. This LGA shows a large anastomosis (arrowheads) with the right gastric artery along the lesser curvature.

Hormonal changes during the fasting versus fed states. Several hormones are released from the GI tract. The “hunger hormone” ghrelin is secreted from X/A cells in the gastric fundus, whereas PYY and GLP-1 are secreted from L cells, primarily from the ileum and colon. Leptin is primarily produced in adipocytes. During fasting, decreased food intake suppresses the release of PYY, GLP-1, and CCK from the gut while stimulating the secretion of ghrelin by the stomach. Fasting also decreases serum leptin levels. These changes are detected by the brain, leading to hunger. Dieting results in a gut hormone profile that mimics the fasted state. During and after regular feeding, there is a reduction in the production of ghrelin by the stomach. In contrast, production of PYY, GLP-1, and CCK from the gut is increased, and serum leptin levels also increase. These changes, which are detected by the brain, result in decreased appetite and a feeling of satiety.

Citation: Weiss, C. R. et al. Bariatric Embolization of the Gastric Arteries for the Treatment of Obesity. Journal of Vascular and Interventional Radiology (2015). doi:10.1016/j.jvir.2015.01.017

Post author: Luke Wilkins, MD

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