Catheter-directed Gastric Artery Chemical Embolization for Modulation of Systemic Ghrelin Levels in a Porcine Model: Initial Experience

Arepally, Aravind; Barnett, Brad P.; Montgomery, Elizabeth; Patel, Tarak H.

doi:10.1148/radiol.2441060790

Cited by 68 publications

(69 citation statements)

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“…Relatively recently, a percutaneous procedure has been described by Arepally et al (12,13), which directly targets the gastric fundus and its functionality. In these investigations, gastric artery chemical embolization (or GACE) was performed by injecting a liquid sclerosing agent, sodium morrhuate, into the main left gastric artery with fluoroscopic guidance.…”

Section: Bariatric Embolizationmentioning

confidence: 99%

“…In these investigations, gastric artery chemical embolization (or GACE) was performed by injecting a liquid sclerosing agent, sodium morrhuate, into the main left gastric artery with fluoroscopic guidance. These studies showed in a porcine model that gastric artery chemical embolization can suppress systemic levels of ghrelin in the short term (12,13). However, liquid sclerosing agents are highly toxic and are difficult to administer via vascular delivery; therefore, they are not a clinically viable option.…”

Section: Bariatric Embolizationmentioning

confidence: 99%

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Bariatric Embolization for Suppression of the Hunger Hormone Ghrelin in a Porcine Model

et al. 2013

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Section: Bariatric Embolizationmentioning

confidence: 99%

Section: Bariatric Embolizationmentioning

confidence: 99%

Bariatric Embolization for Suppression of the Hunger Hormone Ghrelin in a Porcine Model

et al. 2013

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“…GACE-treated swine (n ϭ 5) underwent embolization with 125 g of sodium morrhuate (American Regent, Shirley, NY), while control animals (n ϭ 5) underwent a sham embolization with saline. The dosage was based on results of our prior experiments involving various dosages during GACE (12). After an overnight fast, two blood samples from each animal for baseline ghrelin analysis were obtained simultaneously immediately prior to the procedure.…”

Section: Animal Model and Baseline Blood Samplesmentioning

confidence: 99%

“…was based on results of our prior doseescalating trial for GACE (12). GACEtreated swine that had multiple accessory gastric arteries to the fundus underwent injection of sodium morrhuate into all the accessory gastric arteries, with the volume of sodium morrhuate divided equally among arteries.…”

Section: Experimental Studies: Gastric Artery Chemical Embolization Amentioning

confidence: 99%

“…Recently, we developed a percutaneous procedure, gastric artery chemical embolization (GACE), that directly targets the gastric fundus (a major source of ghrelin) and its functionality with the targeted intraarterial delivery of a sclerosing agent (12). Thus, the purpose of our study was to prospectively test, in a porcine model, the hypothesis that catheter-directed GACE can modulate systemic ghrelin levels and influence weight gain.…”

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Catheter-directed Gastric Artery Chemical Embolization Suppresses Systemic Ghrelin Levels in Porcine Model

Arepally¹,

Barnett

Patel

et al. 2008

Radiology

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Purpose:To prospectively test, in a porcine model, the hypothesis that catheter-directed gastric artery chemical embolization (GACE) can result in suppression of systemic ghrelin levels and affect weight gain. Materials and Methods:This study, which had Animal Care and Use Committee approval, was performed in healthy, growing swine (weight range, 40 -45 kg; n ϭ 10). GACE was performed in five swine with the infusion of sodium morrhuate (125 g) selectively into the gastric arteries that supply the fundus. Five control animals underwent a sham procedure with 5 mL of saline. Weight and fasting plasma ghrelin levels were obtained in animals at baseline and in weeks 1-4. Statistical testing for substantial differences in ghrelin blood levels over time and between treated and untreated animals was performed by using a cross-sectional timeseries linear model with feasibility generalized least squares. Results:The pattern of the change in ghrelin levels over time was significantly different between control and treated animals (P Ͻ .004). In treated animals, ghrelin levels were significantly reduced at week 1 (mean, 664.1 pg/mL Ϯ 103.1 [standard error of the mean], P Ͻ .02), week 2 (mean, 618.1 pg/mL Ϯ 180.4, P Ͻ .001), week 3 (mean, 578.4 pg/mL Ϯ 214.9, P Ͻ .001), and week 4 (mean, 876.6 pg/mL Ϯ 228.6, P Ͻ .03) relative to baseline (mean, 1006.3 pg/mL Ϯ 190.1). The percentage change in serum ghrelin values in swine treated with GACE decreased from baseline to Ϫ34%, Ϫ38.6%, Ϫ42.5%, and Ϫ12.9% during weeks 1-4, respectively. In control swine, percentage change in serum ghrelin was Ϫ1.7%, Ϫ9.7%, ϩ2.6%, and ϩ18.2% during weeks 1-4, respectively. At the end of 4 weeks, control swine continued to gain weight, with a 15.1% increase from their original weight, while the weight in swine treated with GACE plateaued at an increase of 7.8% from the original weight. Conclusion:Catheter-directed GACE can suppress the appetite hormone ghrelin and affect weight gain.

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Transradial left gastric artery embolization to treat severe obesity: A pilot study

Pirlet

Ruzsa

Costerousse

et al. 2018

Cathet Cardio Intervent

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Background Bariatric surgery is currently the only effective treatment with long‐lasting results to treat severe obesity. Objectives We performed a pilot study to evaluate the feasibility, safety and efficacy of percutaneous distal embolization of the left gastric artery (LGA) using a transradial approach. Methods and Results We recruited seven severely obese male patients (mean age 48 ± 7 years) referred for diagnostic coronary angiography. Mean baseline weight was 160 ± 27 kg and body mass index was of 52 ± 8 kg/m2. We successfully injected 300–500 μm polyvinyl alcohol particles using 5Fr catheters and all distal LGA were occluded at the end of procedures. Mean procedure duration was 24 ± 13 min and mean fluoroscopy time was 10 ± 5 min. Six patients reported mild transient epigastric discomfort, which resolved with proton pump inhibitors. At 2 months, the average weight loss was of 7 ± 6 kg (median loss: −10 kg [−2, −11]), 6 ± 12 kg (median loss: −9 kg [−16, +4]) at 6 months and 13 ± 17 kg (median loss: −11 kg [0, −25]) up to 12 months after index procedures. Conclusion Percutaneous transradial LGA embolization appears to be a promising technique to reduce the obesity burden. Randomized trials are required to further delineate the risk/benefit ratio, potential clinical indications and long term results.

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Catheter-directed Gastric Artery Chemical Embolization for Modulation of Systemic Ghrelin Levels in a Porcine Model: Initial Experience

Abstract: Use of GACE can result in increased or suppressed ghrelin levels.

Cited by 68 publications

References 19 publications

Bariatric Embolization for Suppression of the Hunger Hormone Ghrelin in a Porcine Model

Bariatric Embolization for Suppression of the Hunger Hormone Ghrelin in a Porcine Model

Catheter-directed Gastric Artery Chemical Embolization Suppresses Systemic Ghrelin Levels in Porcine Model

Transradial left gastric artery embolization to treat severe obesity: A pilot study

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