Bariatric Embolotherapy Helps Shed Pounds in Obese Patients

Patrice Wendling

June 29, 2020

Transcatheter bariatric embolotherapy (TBE) provides sustained weight loss without serious adverse effects among obese patients, results of a pilot sham-controlled study suggest.

At 6-month follow-up, the patients receiving the intervention had lost 7.4 kg (16.3 lbs) compared with 3.0 kg (6.6 lbs) in those randomized to a sham procedure in an intention-to-treat (ITT) analysis (P = .034).

Results were similar in a per protocol analysis (9.4 kg/20.7 lbs vs 1.9 kg/4.1 lbs; P = .0002).

Weight loss after embolotherapy was sustained over 12 months, falling 7.8 kg (17.1 lbs) from baseline in the ITT population (P = .0011) and 9.3 kg (20.5 lbs) in the per protocol population (P = .0005).

Safety events after TBE were mild nausea or vomiting, reported Vivek Reddy, MD, Mount Sinai Hospital, New York City. Five participants had minor, asymptomatic ulcers that required no additional treatment.

"In this randomized pilot trial, we established the proof of principle that transcatheter bariatric embolotherapy of the left gastric artery is safe and it promotes clinically significant weight loss," he concluded at PCR e-Course, the virtual meeting of the Congress of European Association of Percutaneous Cardiovascular Interventions (EuroPCR) 2020.

Although bariatric surgery is highly effective, he noted that the associated morbidity and mortality limit its use to the severely obese with a body mass index (BMI) typically over 40 kg/m².

TBE is a minimally invasive approach that uses a custom occlusion balloon microcatheter and robotic manifold to inject 300 to 500 µm beads to the left gastric artery. Preclinical and case studies suggest it promotes weight loss by reducing ghrelin, an appetite-stimulating hormone secreted from the gastric fundus, Reddy said.

The study enrolled 44 patients (aged 21 to 60) with a BMI of 35 to 55 kg/m², excluding those with prior bariatric surgery and a history of ulcers, type 2 diabetes, chronic aspirin or non-steroidal inflammatory use, and active Helicobacter pylori infection.

A total of 40 patients were randomly assigned to TBE or a sham procedure, in which lidocaine was applied to the femoral area and propofol infused for 1 hour. The two groups were well matched, with a mean age of 45 vs 46 years, weight of 110 kg vs 119 kg, and BMI of 39 kg/m² vs 40 kg/m², Reddy noted.

Embolotherapy was performed at a single center in Prague, and, on average, took 82.3 minutes and used 127 mL of contrast, 163 Gy/cm² radiation, and 4.2 mL of microspheres. A single vessel was injected in 80% of cases.

The ITT population was comprised of 19 TBE and 18 control subjects, and the per protocol population was comprised of 15 TBE and 16 control subjects, after the exclusion of patients in whom embolotherapy was unsuccessful or incomplete or who withdrew consent.

All patients received endoscopy at baseline and 1 week, as well as an intensive 19-session lifestyle and dietary education intervention out to 6 months.

Patients who underwent TBE had significant improvement in hunger scores at 6 and 12 months, compared with baseline. Similarly, quality of life improved across all six domains, including significant gains in physical function, self-esteem, and overall quality of life at both time points, Reddy reported.

Reddy disclosed receiving research support from Endobar Solutions.

European Association of Percutaneous Cardiovascular Interventions (EuroPCR) 2020 e-Course. Presented June 25, 2020.

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