Non-surgical weight loss procedure
Bariatric embolization is a minimally invasive procedure that blocks the blood flow to the stomach where “microbeads” where the “hunger hormone” grehlin resides. The decreased blood flow decreases appetite.
Bariatric embolization is similar to a long-trusted procedure called arterial embolization, used to treat bleeding ulcers.
The bariatric embolization procedure suppresses the production of the “hunger hormone,” Ghrelin. It is a non-surgical, minimally invasive procedure that promotes weight loss by reducing appetite. In the procedure, microscopic spheres, or micro-beads, are safely introduced through a catheter in the groin or wrist into the left gastric artery. This small arterial blood vessel supplies blood to the area of the stomach where the hunger hormone ghrelin resides. Partially blocking the artery with the micro-beads reduces blood flow to part of the stomach that suppresses production of the hunger-stimulating ghrelin hormones.
Bariatric embolization has emerged in recent years as an alternative to many of the common bariatric surgeries such as gastric bypass, gastric banding, and sleeve gastrectomy. The traditional bariatric surgeries are quite invasive with overnight stays at the hospital, longer recovery times, greater risk for complications, and high cost.
The first Bariatric Embolization procedure completed in the United States was performed at Dayton Interventional Radiology in 2014. Since then, several clinical trials have been carried out which support the safety and early effectiveness of this minimally invasive procedure. Nevertheless, no clinical trial with long-term follow-up and relatively large sample sizes has been reported.
What Exactly is Ghrelin?
Ghrelin is commonly called the “hunger hormone.” Ghrelin hormones are produced by the stomach. When the level of these ghrelin hormones increases, they signal the feeling of hunger to the brain which stimulates appetite and leads to eating. Ghrelin levels decrease after eating food. While ghrelin has broad effects throughout the body, the hormone’s primary function stimulates food intake, promotes fat deposit, and produces growth hormones. This may be the reason diet programs fail for many. Diet regiments for weight loss have been shown to be difficult to sustain, due to increase in hunger. Thus, it may not be a surprise that dieting induces a 24% increase in the 24-hour ghrelin profile. This elevated ghrelin secretion may therefore be a reason why dieting is so difficult to sustain in the long term.
Obesity
The first criteria to be a candidate for the procedure is to have a body mass index (BMI) greater than 30. Candidates for the procedure include those that have had multiple, unsuccessful attempts at weight loss in the past through diet, exercise and behaviour modification. If you have tried calorie counting, working out with a combination of meal replacements or other various diet programs without sustained weight loss than you may be a candidate. Individuals who have had previous bariatric surgery are not eligible for the procedure.
Long recognized as a global pandemic, the prevalence of obesity has nearly doubled since 1980. Overall, more than 10% of the global adult population is classified as obese, which is defined by a body mass index (BMI; weight in kilograms divided by the square of height in meters) greater than or equal to 30.
Obesity is a multifactorial condition that is influenced by genetics, the environment and other diseases, drugs, or psychologic factors. As with other multifactorial conditions, treatment of obesity requires that a multidisciplinary approach be tailored to the individual.
Obesity is associated with an increase in conditions such as heart disease, high cholesterol, high blood pressure, diabetes, stroke, sleep apnea and even cancer. Obesity related illness are the number one cause of preventable death in the United States.
Who is a Candidate?
The first criteria to be a candidate for the procedure is to have a body mass index (BMI) greater than 30. Candidates for the procedure include those that have had multiple, unsuccessful attempts at weight loss in the past through diet, exercise and behaviour modification. If you have tried calorie counting, working out with a combination of meal replacements or other various diet programs without sustained weight loss than you may be a candidate. Individuals who have had previous bariatric surgery are not eligible for the procedure.
A meta-analysis, involving 47 patients from six prospective clinical trials showed that a mean weight loss, observed after an average follow-up time period of 12 months following left gastric embolization (LGE) procedure was approximately 8% of baseline total body weight. However, one of the studies showed much better results with the mean weight loss reported just over 17%.
Mean weight loss percentage for each study following left gastric embolization procedure are mentioned in the table below:
Comparing it to other procedures, the percentage of weight loss was up to 36% after roux-en-y gastric bypass and 19% by gastric banding. The potential benefits of gastric bypass must be weighed against the known complications. Bleeding, infection, postoperative development of deep venous thrombosis, internal leaks at the incision site, respiratory problems, and death can complicate the early postoperative period.
Longer-term complications include malnutrition, vitamin and protein deficiencies, gastric dumping syndrome, anastomotic stricture, staple-line failure, internal hernia, adhesions, pouch dilatation, and failure to lose a sufficient amount of weight.
What to Expect?
The first step is to schedule an appointment. This will allow an in-depth explanation of the procedure, required blood tests and other investigations and answer any questions you may have.
It is advisable to meet with a Bariatric surgeon beforehand so that you are well informed of alternative options available which may be better suited to you. This is especially so because the results obtained from the surgical procedures are better and their techniques are well established, and time tested.
If you are not a surgical candidate or do not want to risk the complications of surgery or your personal preference is to opt for a minimally invasive technique, then gastric embolization is an available option.
Additional Benefits Following gastric embolization:
The effect of LGE procedure on lowering lipid profile, HgA1C, and metabolic syndrome is not clear, although some clinical trials show promising results with significant metabolic changes after 12 months of follow up in levels of total cholesterol, low-density lipoprotein, mean blood glucose, and HgA1C, independent of weight loss.
Safety of Bariatric Embolization:
Preliminary clinical studies show that this is a safe and well-tolerated procedure. For the most part only minor adverse effects were noted after the procedure including nausea, transient vomiting and epigastric pain.
Major complications include gastric ulceration and perforation and therefore all patients are screened by our gastroenterologist and sometimes require endoscopy prior to proceeding with the embolization procedure. Other complications have been reported but are very infrequent.
