Bariatric embolization shows promise as obesity treatment

Last Updated: 2019-04-05

By Will Boggs MD

NEW YORK (Reuters Health) - Transarterial embolization of the gastric fundus ("bariatric embolization") leads to appetite suppression and weight loss in adults with obesity, according to results from the BEAT Obesity trial.

"Most patients described an immediate and prolonged reduction in appetite as well as development of early satiety," said Dr. Clifford R. Weiss of the Johns Hopkins University School of Medicine, in Baltimore, Maryland.

"This suggests that the procedure will be a tool to help patients adhere to existing lifestyle-management plans (adding to the ability of the patient to achieve weight loss)," he told Reuters Health by email.

Image-guided bariatric embolization aims to induce metabolic changes similar to those induced by bariatric surgery by targeting the endocrine functions of the gastric fundus, which plays a role in stimulating appetite. Early clinical trials have produced encouraging short-term results.

Dr. Weiss's team evaluated the safety and efficacy of bariatric embolization in their pilot trial of 20 severely obese adults (mean BMI, 45) at up to 12 months after the procedure.

Bariatric embolization was performed successfully in all participants, and all participants were discharged home 24-48 hours after the procedure.

Weight loss averaged 7.6 kg at 12 months, with mean excess weight loss of 8.2% at one month, 11.5% at three months, 12.8% at six months, and 11.5% at 12 months, the researchers report in Radiology, online April 2.

Mean appetite scores decreased from 57.49 at baseline to 29.40 within 1 week and remained decreased at 52 weeks (mean, 42.47).

One participant had mild gastritis in the gastric body at the three-month endoscopy, one had delayed gastric emptying at one month that resolved by six months, and eight participants had superficial, asymptomatic ulcers at the two-week endoscopy in locations consistent with fundal symbolization. All ulcers healed by three months.

Weight-related quality-of-life scores improved gradually and significantly beginning at three months after embolization.

Participants also experienced decreases in mean total cholesterol and LDL cholesterol, as well as decreases in mean blood glucose level and hemoglobin A1c.

"This is exciting data that suggests that this new procedure may play a role in the future management of a complex and deadly disease, obesity," Dr. Weiss said. "I would like people to realize that there are ongoing clinical trials to further understand this procedure and whether indeed it has a role to play in the management of the obese patient."

"Physicians should be aware of local and national clinical trials and refer their patients, if they believe they could benefit," he said. "Patients undergoing this procedure as part of clinical trials should be aware that it is experimental and that the long-term impacts are not yet known."

"Of note, this is not surgery," Dr. Weiss explained. "No incisions are made, nothing is resected, no physical restrictions are placed on any organs. Instead, this is a minimally invasive endovascular procedure - designed to block the blood supply to the gastric fundus, leading to a change in gastric function. We believe this is due, in part, to a reduction in the production of the hunger hormone ghrelin."

Dr. Alexander S. Pasciak of Johns Hopkins, who was not involved in this study but earlier demonstrated the technical feasibility and safety of bariatric radioembolization in pigs, told Reuters Health by email, "One of the primary initial concerns about bariatric embolization relates to the durability of the treatment, since revascularization of fundal tissue is likely in the short term. Therefore, I was pleased to see that a measure of treatment durability was found in this study extending out to 12 months."

"While there is still additional work that needs to be done, including the addition of placebo control, clinicians who care for morbidly obese patients should closely follow the progress of this treatment as future investigations are published," he said.

Dr. Gao-Jun Teng from Zhongda Hospital, Southeast University, in Nanjing, China, who recently reported results of bariatric embolization in five obese adults, told Reuters Health by email, "From this research, we are pleased to see that the effectiveness of bariatric arterial embolization (BAE) lasted for at least one year, or even longer. Our own previous prospective trial also demonstrated that BAE has potential to maintain weight loss for at least 9 months."

"Despite the promising outcomes of this study, several issues should be addressed before regarding BAE as a recognized approach for obesity," he said. "Firstly, is a repeat bariatric embolization helpful for an unsatisfactory previous BAE? Secondly, who are the ideal candidates for BAE? Thirdly, what is the standard technique to perform BAE, including embolic agents, size of agents, criteria for successful BAE, etc.?"

Dr. Nicholas Kipshidze of the Cardiovascular Research Foundation in New York City, who reported the first human study of gastric artery embolization for weight loss in 2012, said, "Bariatric embolization may fill the gap in bariatric therapy between pharmacological/behavioral interventions (and/or short-term endoscopic treatments, such as intragastric balloons) and bariatric surgery. On one side, it's less invasive/safer than bariatric surgery - even though less effective - and it's safe and effective enough to target obese populations where drugs and/or short-term endoscopic treatments are not effective."

"Bariatric embolization is not to replace standard bariatric surgery, however, but to widen access to effective obesity treatment to the so far (due to different reasons and obstacles) 'underserved' population, especially with cardiovascular comorbidities," Dr. Kipshidze, who also was not involved in the new study, told Reuters Health by email.

SOURCE: https://bit.ly/2YSGeKj

Radiology 2019.