Metabolic outcomes of left gastric artery embolization in obese patients (a pilot study)

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Abstract

Rationale: According to the published data, bariatric procedure of left gastric artery embolization (LGAE) as one of the minimally invasive and innovative methods for obesity treatment promotes reductions in bodyweight and ghrelin levels.

Aim: To evaluate the effect of LGAE on the parameters of fat and carbohydrate metabolism in obese patients.

Materials and methods: Twenty three (23) patients (10 male and 13 female, mean age 40.2 ± 10.6 years) with morbid obesity (body mass index [BMI] > 40 kg/m2) and obesity grade 2 (BMI > 35 kg/m2) underwent a minimally invasive procedure in the form of bariatric embolization of the left gastric artery with polyvinyl alcohol particles of 500 to 700 mcm in diameter. We compared anthropometric parameters (height in cm, body-weight in kg, BMI in kg/m2, waist circumference in cm) at baseline and at 6 months after LGAE. Laboratory examinations included measurements of plasma adiponectin, ghrelin, leptin, fasting glucose, HbA1c, insulin, and HOMA-IR (insulin resistance index).

Results: At 6 month after LGAE, the patients' bodyweight decreased from 138.1 ± 33.2 kg to 113 ± 26 kg (p < 0.01) (by 18.2%), BMI from 47.4 ± 9.3 kg/m2 to 38.1 ± 7.4 kg/m2 (p < 0.01) (by 19.6%), waist circumference from 130.4 ± 9.7 cm to 115 ± 10.3 cm (p < 0.01) (by 11.8%). Mean adiponectin levels increased significantly from 22.5 ± 8.1 μg/ml before LGAE to 42.4 ± 11 μg/ml at 6 months (p < 0.001) (by 88.4%). Baseline ghrelin levels of 20.23 ± 4.8 femtomol/μL decreased to 2.09 ± 0.6 femtomol/μL at 6 months (p < 0.001) (by 89.6%). Mean leptin levels were 23.3 ± 4.9 ng/ml and 10.5 ± 3.7 ng/ml at baseline and at 6 months, respectively (p < 0.001) (by 54.9%). At 6 months after LGAE, there was a positive and significant trends in the parameters of carbohydrate metabolism: fasting glucose decreased from 6.9 ± 1.5 mmol/L to 5.1 ± 0.9 mmol/L (p < 0.001) (by 26%), HbA1c from 6.2 ± 1% to 5.3 ± 0.6% (p < 0.01) (by 14.5%), insulin from 15.6 ± 7.7 μU/ml to 8.1 ± 0.7 μU/ml (p < 0.001) (by 48%), and the HOMA-IR index from 4.5 ± 1.2 to 1.9 ± 0.32 (p < 0.001) (by 57.7%).

Conclusion: At 6 months after LGAE, the patients with obesity grades 2 and 3 have demonstrated a reduction in bodyweight of 18–19%, with a decrease in the levels of leptin (the obesity hormone), ghrelin (hunger inducing hormone), and an increase in adiponectin levels, which is a marker of metabolic health. The patients also achieved their individual glycemic goals with a decrease in fasting glucose, insulin, glycated hemoglobin, and demonstrated an improvement in HOMA-IR.

About the authors

Z. D. Ramazanova

Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: zaira.ramazanova.92@bk.ru
ORCID iD: 0000-0003-0566-807X

Zaira D. Ramazanova – Postgraduate Student, Chair of Endocrinology

95–3–87 Leninskiy prospekt, Moscow, 119313

Russian Federation

A. S. Ametov

Russian Medical Academy of Continuous Professional Education

Email: alexsander.ametov@gmail.com
ORCID iD: 0000-0002-7936-7619

Alexandr S. Ametov – MD, PhD, Professor, Head of Chair of Endocrinology

2/1–1 Barrikadnaya ul., Moscow, 125993

Russian Federation

E. Yu. Pashkova

Russian Medical Academy of Continuous Professional Education;
S.P. Botkin Municipal Clinical Hospital

Email: parlodel@mail.ru
ORCID iD: 0000-0003-1949-914X

Evgeniya Yu. Pashkova – MD, PhD, Associate Professor, Chair of Endocrinology Russian Medical Academy of Continuous Professional Education; Head of Department of Endocrinology S.P. Botkin Municipal Clinical Hospital

2/1–1 Barrikadnaya ul., Moscow, 125993; 

5 2-y Botkinskiy proezd, Moscow, 125284

Russian Federation

R. G. Khovalkin

Urban Clinical Hospital Number 29 them. N.E. Bauman

Email: ruslan_khovalkin@mail.ru
ORCID iD: 0000-0001-7826-4768

Ruslan G. Khovalkin – MD, PhD, Head of Department of X-ray Endovascular Methods of Diagnostics and Treatment

2 Gospital'naya ploschad', Moscow, 111020

Russian Federation

M. I. Shpitonkov

Federal Research Center "Сomputer Science and Control"

Email: moscow.mixash@bk.ru
ORCID iD: 0000-0002-7594-049X

Mikhail I. Shpitonkov – PhD (in Phys. and Math.), Associate Professor, Senior Research Fellow

44–2 Vavilova ul., Moscow, 119333

Russian Federation

References

  1. Mohammed MS, Sendra S, Lloret J, Bosch I. Systems and WBANs for Controlling Obesity. J Healthc Eng. 2018;2018:1564748. doi: 10.1155/2018/1564748.
  2. Аметов АС. Сахарный диабет 2 типа. Проблемы и решения. Т. 2. В: Яшков ЮИ, Карпова ЕВ, Аметов АС. Бариатрическая хирургия в лечении сахарного диабета 2-го типа и ожирения. М.: ГЭОТАР-Медиа; 2015. с. 203–210.
  3. Lee WJ, Almalki O. Recent advancements in bariatric/metabolic surgery. Ann Gastroenterol Surg. 2017;1(3): 171–179. doi: 10.1002/ags3.12030.
  4. Syed MI, Shaikh A, Patel S, Ikramuddin I, Morar K. Bariatric embolization for obesity: A new frontier for interventional medicine [Internet]. Endovascular Today. 2017;16(4): 76–86. Available from: https://evtoday.com/pdfs/et0417_F3_Syed.pdf.
  5. Anton K, Rahman T, Bhanushali A, Patel AA. Bariatric Left Gastric Artery Embolization for the Treatment of Obesity: A Review of Gut Hormone Involvement in Energy Homeostasis. AJR Am J Roentgenol. 2016;206(1): 202–210. doi: 10.2214/AJR.15.14331.
  6. Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402(6762): 656–660. doi: 10.1038/45230.
  7. Arepally A, Barnett BP, Patel TH, Howland V, Boston RC, Kraitchman DL, Malayeri AA. Catheter-directed gastric artery chemical embolization suppresses systemic ghrelin levels in porcine model. Radiology. 2008;249(1): 127–133. doi: 10.1148/radiol.2491071232.
  8. Paxton BE, Kim CY, Alley CL, Crow JH, Balmadrid B, Keith CG, Kankotia RJ, Stinnett S, Arepally A. Bariatric embolization for suppression of the hunger hormone ghrelin in a porcine model. Radiology. 2013;266(2): 471–479. doi: 10.1148/radiol.12120242.
  9. Gunn AJ, Oklu R. A preliminary observation of weight loss following left gastric artery embolization in humans. J Obes. 2014;2014:185349. doi: 10.1155/2014/185349.
  10. Weiss CR, Gunn AJ, Kim CY, Paxton BE, Kraitchman DL, Arepally A. Bariatric embolization of the gastric arteries for the treatment of obesity. J Vasc Interv Radiol. 2015;26(5): 613–624. doi: 10.1016/j.jvir.2015.01.017.
  11. Fiaschi T. Mechanisms of Adiponectin Action. Int J Mol Sci. 2019;20(12): 2894. doi: 10.3390/ijms20122894.
  12. Syed MI, Morar K, Shaikh A, Craig P, Khan O, Patel S, Khabiri H. Gastric Artery Embolization Trial for the Lessening of Appetite Nonsurgically (GET LEAN): Six-Month Preliminary Data. J Vasc Interv Radiol. 2016;27(10): 1502–1508. doi: 10.1016/j.jvir.2016.07.010.
  13. Zaitoun MMA, Basha MAA, Hassan F, Elsayed SB, Farag AA, Amer M, Aly SA, Zaitoun N. Left Gastric Artery Embolization in Obese, Pre-diabetic Patients: A Pilot Study. J Vasc Interv Radiol. 2019;30(6): 790–796. doi: 10.1016/j.jvir.2019.02.010.
  14. Weiss CR, Akinwande O, Paudel K, Cheskin LJ, Holly B, Hong K, Fischman AM, Patel RS, Shin EJ, Steele KE, Moran TH, Kaiser K, Park A, Shade DM, Kraitchman DL, Arepally A. Clinical Safety of Bariatric Arterial Embolization: Preliminary Results of the BEAT Obesity Trial. Radiology. 2017;283(2): 598–608. doi: 10.1148/radiol.2016160914.

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Copyright (c) 2021 Ramazanova Z.D., Ametov A.S., Pashkova E.Y., Khovalkin R.G., Shpitonkov M.I.

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