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 & 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 Another blood sample was withdrawn to assess the change in serum Ghrelin level.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.
FIRST–IN–MAN STUDY OF LEFT GASTRIC ARTERY EMBOLIZATION FOR WEIGHT LOSS
