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

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.