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Khurana R, Pandey NN, Kumar S, Jagia P. Bariatric arterial embolization in patients with body mass index ranging from 25 to 40 kg/m 2: A systematic review & meta-analysis. J Cardiovasc Thorac Res 2023; 15:196-203. [PMID: 38357559 PMCID: PMC10862037 DOI: 10.34172/jcvtr.2023.32900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024] Open
Abstract
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.
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Affiliation(s)
- Rishabh Khurana
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Wang Z, Zhu D, Zhu X, Liu D, Cao Q, Pan T, Zhang Q, Gu X, Li L, Teng G. Interventional metabology: A review of bariatric arterial embolization and endovascular denervation for treating metabolic disorders. J Diabetes 2023; 15:665-673. [PMID: 37438984 PMCID: PMC10415876 DOI: 10.1111/1753-0407.13437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Abstract
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.
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Affiliation(s)
- Zhi Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Dan‐Qi Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Xiang‐Yun Zhu
- Department of Endocrinology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
- Institute of PancreasSoutheast UniversityNanjingChina
| | - De‐Chen Liu
- Department of Endocrinology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
- Institute of PancreasSoutheast UniversityNanjingChina
| | - Qing‐Yue Cao
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Tao Pan
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Qi Zhang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Xiao‐Chun Gu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Ling Li
- Department of Endocrinology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
- Institute of PancreasSoutheast UniversityNanjingChina
| | - Gao‐Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of MedicineSoutheast UniversityNanjingChina
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Tang Y, Pan X, Peng G, Tong N. Weight Loss and Gastrointestinal Hormone Variation Caused by Gastric Artery Embolization: An Updated Analysis Study. Front Endocrinol (Lausanne) 2022; 13:844724. [PMID: 35370934 PMCID: PMC8967156 DOI: 10.3389/fendo.2022.844724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Many gastric artery embolizations (GAE) have been performed in recent years. We try to determine whether GAE caused weight loss by decreasing gastrointestinal hormone through the analysis of weight loss and gastrointestinal hormones changes. METHODS The PubMed and Medline databases, and the Cochrane Library, were searched using the following keywords. A total of 10 animal trials (n=144), 15 human trials (n=270) were included for analysis. After GAE, we mainly evaluated the changes in body weight loss (BWL) and body mass index (BMI), as well as metabolic indexes, such as blood glucose, lipids, and gastrointestinal hormones levels. RESULTS Animal subjects received either chemical or particle embolization, while human subjects only received particle embolization. In animal trials (growing period), the GAE group gained weight significantly slower than the sham-operated group, ghrelin levels decreased. In human trials, GAE brought more weight loss in the early stages, with a trend towards weight recovery after several months that was still lower than baseline levels. Besides weight loss, abnormal metabolic indicators, such as blood glucose and lipids were modified, and the quality of life (QOL) scores of obese patients improved. In addition, weight loss positively correlates with ghrelin. CONCLUSION GAE may help people lose weight and become a new minimally invasive and effective surgery for the treatment of modest obesity. Physiologic changes in gastrointestinal tract of gastrointestinal hormones level may be one reason for weight loss in GAE.
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Affiliation(s)
- Yi Tang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetes and Islet Transplantation Research, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaohui Pan
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetes and Islet Transplantation Research, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Ge Peng
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetes and Islet Transplantation Research, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
| | - Nanwei Tong
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Diabetes and Islet Transplantation Research, Center for Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Nanwei Tong,
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Distal Radial Artery Access for Coronary and Peripheral Procedures: A Multicenter Experience. J Clin Med 2021; 10:jcm10245974. [PMID: 34945269 PMCID: PMC8707635 DOI: 10.3390/jcm10245974] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Distal radial access (dRA) has recently gained global popularity as an alternative access route for vascular procedures. Among the benefits of dRA are the low risk of entry site bleeding complications, the low rate of radial artery occlusion, and improved patient and operator comfort. The aim of this large multicenter registry was to demonstrate the feasibility and safety of dRA in a wide variety of routine procedures in the catheterization laboratory, ranging from coronary angiography and percutaneous coronary intervention to peripheral procedures. METHODS The study comprised 1240 patients who underwent coronary angiography, PCI or noncoronary procedures through dRA in two Hungarian centers from January 2019 to April 2021. Baseline patient characteristics, number and duration of arterial punctures, procedural success rate, crossover rate, postoperative compression time, complications, hospitalization duration, and different learning curves were analyzed. RESULTS The average patient age was 66.4 years, with 66.8% of patients being male. The majority of patients (74.04%) underwent a coronary procedure, whereas 25.96% were involved in noncoronary interventions. dRA was successfully punctured in 97% of all patients, in all cases with ultrasound guidance. Access site crossover was performed in 2.58% of the patients, mainly via the contralateral dRA. After experiencing 150 cases, the dRA success rate plateaued at >96%. Our dedicated dRA step-by step protocol resulted in high open radial artery (RA) rates: distal and proximal RA pulses were palpable in 99.68% of all patients at hospital discharge. The rate of minor vascular complications was low (1.5%). A threshold of 50 cases was sufficient for already skilled radial operators to establish a reliable procedural method of dRA access. CONCLUSION The implementation of distal radial artery access in the everyday routine of a catheterization laboratory for coronary and noncoronary interventions is feasible and safe with an acceptable learning curve.
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Mizandari M, Keshavarz P, Azrumelashvili T, Yazdanpanah F, Lorzadeh E, Hosseinpour H, Bazyar A, Nejati SF, Ebrahimian Sadabad F. Left gastric artery embolization for obesity treatment: a systematic review and meta-analysis of human and animal studies. Abdom Radiol (NY) 2021; 46:4440-4451. [PMID: 33825928 DOI: 10.1007/s00261-021-03036-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION The present study concluded that ghrelin levels in humans had not been affected, although bariatric LGA embolization might significantly improve BMI and weight.
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Affiliation(s)
- Malkhaz Mizandari
- Department of Diagnostic & Interventional Radiology, New Hospitals LTD, 12 Krtsanisi., 0114, Tbilisi, Georgia.
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia.
| | - Pedram Keshavarz
- Department of Diagnostic & Interventional Radiology, New Hospitals LTD, 12 Krtsanisi., 0114, Tbilisi, Georgia
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tamta Azrumelashvili
- Department of Diagnostic & Interventional Radiology, New Hospitals LTD, 12 Krtsanisi., 0114, Tbilisi, Georgia
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - Fereshteh Yazdanpanah
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tabriz, Iran
| | - Elnaz Lorzadeh
- Department of Nutrition, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamidreza Hosseinpour
- Department of Surgery, Shiraz Laparoscopic Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Bazyar
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Faraz Nejati
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faranak Ebrahimian Sadabad
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Yuan F, Latif MA, Shafaat O, Prologo JD, Hill JO, Gudzune KA, Marrone AK, Kraitchman DL, Rogers AM, Khaitan L, Oklu R, Pereira K, Steele K, White SB, Weiss CR. Interventional Radiology Obesity Therapeutics: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel. J Vasc Interv Radiol 2021; 32:1388.e1-1388.e14. [PMID: 34462083 DOI: 10.1016/j.jvir.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 02/06/2023] Open
Abstract
The Society of Interventional Radiology Foundation commissioned a Research Consensus Panel to establish a research agenda on "Obesity Therapeutics" in interventional radiology (IR). The meeting convened a multidisciplinary group of physicians and scientists with expertise in obesity therapeutics. The meeting was intended to review current evidence on obesity therapies, familiarize attendees with the regulatory evaluation process, and identify research deficiencies in IR bariatric interventions, with the goal of prioritizing future high-quality research that would move the field forward. The panelists agreed that a weight loss of >8%-10% from baseline at 6-12 months is a desirable therapeutic endpoint for future IR weight loss therapies. The final consensus on the highest priority research was to design a blinded randomized controlled trial of IR weight loss interventions versus sham control arms, with patients receiving behavioral therapy.
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Affiliation(s)
- Frank Yuan
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad A Latif
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Omid Shafaat
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J David Prologo
- Department of Radiology, Division of Vascular and Interventional Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - James O Hill
- Department of Nutrition Sciences, School of Health Professions, Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly A Gudzune
- Department of Obesity Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - April K Marrone
- Division of Renal, Gastrointestinal, Obesity and Transplant Devices, Office of GastroRenal, ObGyn, General Hospital and Urology Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Dara L Kraitchman
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann M Rogers
- Department of Surgery, Penn State Health Surgical Specialties, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Leena Khaitan
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Rahmi Oklu
- Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, Scottsdale, Arizona
| | - Keith Pereira
- Department of Radiology, Division of Interventional Radiology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Kimberley Steele
- Department of General Surgery, Bariatric Surgery Program, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Clifford R Weiss
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Sangiorgi GM, Cereda A, Porchetta N, Benedetto D, Matteucci A, Bonanni M, Chiricolo G, De Lorenzo A. Endovascular Bariatric Surgery as Novel Minimally Invasive Technique for Weight Management in the Morbidly Obese: Review of the Literature. Nutrients 2021; 13:nu13082541. [PMID: 34444701 PMCID: PMC8401754 DOI: 10.3390/nu13082541] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/28/2021] [Accepted: 07/21/2021] [Indexed: 12/13/2022] Open
Abstract
Nowadays, obesity represents one of the most unresolved global pandemics, posing a critical health issue in developed countries. According to the World Health Organization, its prevalence has tripled since 1975, reaching a prevalence of 13% of the world population in 2016. Indeed, as obesity increases worldwide, novel strategies to fight this condition are of the utmost importance to reduce obese-related morbidity and overall mortality related to its complications. Early experimental and initial clinical data have suggested that endovascular bariatric surgery (EBS) may be a promising technique to reduce weight and hormonal imbalance in the obese population. Compared to open bariatric surgery and minimally invasive surgery (MIS), EBS is much less invasive, well tolerated, with a shorter recovery time, and is probably cost-saving. However, there are still several technical aspects to investigate before EBS can be routinely offered to all obese patients. Further prospective studies and eventually a randomized trial comparing open bariatric surgery vs. EBS are needed, powered for clinically relevant outcomes, and with adequate follow-up. Yet, EBS may already appear as an appealing alternative treatment for weight management and cardiovascular prevention in morbidly obese patients at high surgical risk.
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Affiliation(s)
- Giuseppe Massimo Sangiorgi
- Department of Biomedicine and Prevention, Institute of Cardiology, Cardiac Cath Lab, University of Rome Tor Vergata, 00133 Rome, Italy; (N.P.); (D.B.); (A.M.); (M.B.); (G.C.); (A.D.L.)
- Correspondence:
| | - Alberto Cereda
- Department of Cardiology, Cardiac Cath Lab, San Gaudenzio Clinic, 28100 Novara, Italy;
| | - Nicola Porchetta
- Department of Biomedicine and Prevention, Institute of Cardiology, Cardiac Cath Lab, University of Rome Tor Vergata, 00133 Rome, Italy; (N.P.); (D.B.); (A.M.); (M.B.); (G.C.); (A.D.L.)
| | - Daniela Benedetto
- Department of Biomedicine and Prevention, Institute of Cardiology, Cardiac Cath Lab, University of Rome Tor Vergata, 00133 Rome, Italy; (N.P.); (D.B.); (A.M.); (M.B.); (G.C.); (A.D.L.)
| | - Andrea Matteucci
- Department of Biomedicine and Prevention, Institute of Cardiology, Cardiac Cath Lab, University of Rome Tor Vergata, 00133 Rome, Italy; (N.P.); (D.B.); (A.M.); (M.B.); (G.C.); (A.D.L.)
| | - Michela Bonanni
- Department of Biomedicine and Prevention, Institute of Cardiology, Cardiac Cath Lab, University of Rome Tor Vergata, 00133 Rome, Italy; (N.P.); (D.B.); (A.M.); (M.B.); (G.C.); (A.D.L.)
| | - Gaetano Chiricolo
- Department of Biomedicine and Prevention, Institute of Cardiology, Cardiac Cath Lab, University of Rome Tor Vergata, 00133 Rome, Italy; (N.P.); (D.B.); (A.M.); (M.B.); (G.C.); (A.D.L.)
| | - Antonino De Lorenzo
- Department of Biomedicine and Prevention, Institute of Cardiology, Cardiac Cath Lab, University of Rome Tor Vergata, 00133 Rome, Italy; (N.P.); (D.B.); (A.M.); (M.B.); (G.C.); (A.D.L.)
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Bariatric Embolization in the Treatment of Patients with a Body Mass Index Between 30 and 39.9 kg/m 2 (Obesity Class I and II) and Metabolic Syndrome, a Pilot Study. Cardiovasc Intervent Radiol 2021; 44:598-606. [PMID: 33527186 DOI: 10.1007/s00270-021-02776-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To evaluate the efficacy and clinical safety of bariatric arterial embolization (BAE) in adults with body mass index (BMI) between 30 and 39.9 kg/m2 and metabolic syndrome (MS). MATERIALS AND METHODS Between March and August 2018, ten female participants between 21 and 48-years-old, median BMI of 36.37 ± 2.58 kg/m2 and MS were 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, efficacy was assessed by changes in total body weight (TBW), ghrelin and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) levels and by changes in quality of life (QOL) and in binge eating scale (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. RESULTS Six months after embolization, TBW decreased by 6.8% (6.22 kg ± 3.6;p = .01), serum ghrelin dropped from 25.39 pg/ml ± 10.63 to 17.1 ± 8.07 (p = 0.01), and HOMA-IR decreased from 7.29 ± 5.66 to 3.73 ± 1.99 (p = 0.01). The QOL scores improved from 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 symptomatic gastric 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. CONCLUSION 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.
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Weiss CR, Bailey CR. Bariatric Arterial Embolization: Are We There Yet? J Am Coll Cardiol 2020; 76:2318-2320. [PMID: 33183505 DOI: 10.1016/j.jacc.2020.09.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Clifford R Weiss
- Department of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
| | - Christopher R Bailey
- Department of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, Maryland
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10
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Aldawudi I, Katwal PC, Jirjees S, Htun ZM, Khan S. Future of Bariatric Embolization: A Review of Up-to-date Clinical Trials. Cureus 2020; 12:e7958. [PMID: 32509483 PMCID: PMC7270878 DOI: 10.7759/cureus.7958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Israa Aldawudi
- Radiology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Prakash C Katwal
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Srood Jirjees
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Zin Mar Htun
- Internal Medicine, California Institute of Behavioral Neuroscience and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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11
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Caputo RP. Editorial: Transradial Access - to the Heart of the Matter and More. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:227-229. [PMID: 32199666 DOI: 10.1016/j.carrev.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ronald P Caputo
- St. Joseph's Cardiovascular Specialists, 4939 Brittonfield Pkwy, Suite 202, East Syracuse, NY 13058.
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12
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Hafezi-Nejad N, Bailey CR, Weiss CR. Bariatric Embolization: A Narrative Review of Clinical Data From Human Trials. Tech Vasc Interv Radiol 2020; 23:100658. [PMID: 32192638 DOI: 10.1016/j.tvir.2020.100658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bariatric arterial embolization (BAE) is a novel technique that is investigated as an alternative, often supplementary, method for weight management. BAE reduces blood perfusion to the gastric fundus, and thus, reduces the production of appetite-inducing hormones. No randomized controlled trial has evaluated the efficacy of BAE to date. Available evidence from published studies include retrospective evaluations of patients undergoing left gastric artery embolization for gastrointestinal bleeding, and early prospective, single-arm clinical trials. Review of clinical data from human trials suggest an average weight loss of about 8-9 kg (ranging 7.6-22.0 kg), corresponding to 8-9% (ranging 4.8-17.2%) of the patients' baseline weight. Common complications include superficial gastric ulcers. Though uncommon, gastric perforation and splenic infarct are important major complication that may arise after left gastric artery embolization. Overall, BAE is an effective, relatively safe procedure that may be associated with clinically significant weight loss in patients with obesity.
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Affiliation(s)
- Nima Hafezi-Nejad
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Christopher R Bailey
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD.
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Hafezi-Nejad N, Bailey CR, Gunn AJ, Weiss CR. Weight Loss after Left Gastric Artery Embolization: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2019; 30:1593-1603.e3. [DOI: 10.1016/j.jvir.2019.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
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14
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Left Gastric Artery Embolization in Obese, Prediabetic Patients: A Pilot Study. J Vasc Interv Radiol 2019; 30:790-796. [DOI: 10.1016/j.jvir.2019.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022] Open
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Gunn AJ, Weiss CR. Is There a Role for Bariatric Embolization in the Treatment of the Diabetic Patient? J Vasc Interv Radiol 2019; 30:797-800. [PMID: 31126595 DOI: 10.1016/j.jvir.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andrew J Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Department of Radiology, Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287.
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Research progress of bariatric embolization for treatment of obesity. Chin Med J (Engl) 2019; 132:880-882. [PMID: 30897604 PMCID: PMC6595855 DOI: 10.1097/cm9.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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Gilchrist IC. A catheter-based bariatric procedure: Wishful thinking or an intriguing concept. Catheter Cardiovasc Interv 2019; 93:371-372. [PMID: 30770664 DOI: 10.1002/ccd.28139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/12/2022]
Abstract
Left gastric artery embolization acutely lowers ghrelin levels and is associated with modest weight loss sustainable for 1 year in morbidly obese patients. The procedure is relative quick, free of access complications when done via the radial artery, but long-term sequelae and the durability of ischemic injury to the fundus of the stomach is uncertain. Present reports provide pilot and proof-of-concept data that should fashion further study, but application to routine practice today is premature.
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Affiliation(s)
- Ian C Gilchrist
- MS Hershey Medical Center, College of Medicine, Heart and Vascular Institute, Penn State University, Hershey, Pennsylvania
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