Transcatheter bariatric embolotherapy of the left gastric artery may be well-tolerated and promote clinically significant weight loss over a sham procedure, according to a study published Nov. 9 in the Journal of the American College of Cardiology.

Vivek Y. Reddy, MD, et al., examined 44 obese subjects (body mass index 35 – 55 kg/m2 ) that were randomized 1:1 to either sham or transcatheter bariatric embolotherapy targeting the left gastric artery using an occlusion balloon microcatheter to administer 300- to 500-mm embolic beads. Patients and physicians performing follow-up were blind to the allocated therapy, and endoscopy was performed at baseline and one-week post-procedure.

Results showed that in the transcatheter bariatric embolotherapy group, patients reported mild nausea and vomiting, and endoscopy revealed only minor self-limiting ulcers in five patients. According to the authors, beyond the self-limited nausea and vomiting, the procedures were "very well tolerated."

At six months, in both the intention-to-treat and per-protocol populations, the authors found that the total body weight loss was greater with transcatheter bariatric embolotherapy (7.4 kg/6.4% and 9.4 kg/8.3% loss, respectively) than sham (3.0 kg/2.8% and 1.9 kg/1.8%, respectively). At 12 months, the total body weight loss was maintained with transcatheter bariatric embolotherapy (intention-to-treat 7.8 kg/6.5% loss, per-protocol 9.3 kg/9.3% loss).

Furthermore, transcatheter bariatric embolotherapy was shown to be a safe procedure with minimal complications. Ulcerations were all reported within one week of the procedure, were of minimal severity and were easily treated.

"Although a panacea for obesity is unlikely, these data indicate that, if confirmed to be safe and effective in larger future trials, embolotherapy might play an important role in mitigating this global health epidemic," the authors conclude.

In a related editorial comment, Clifford R. Weiss, MD, and Christopher R. Bailey, MD, note that "when combined with the previous published data, the data from the current randomized controlled trial from Reddy et al., further demonstrate that bariatric arterial embolization is well-tolerated and effective in inducing mild/moderate weight loss up to at least the 12-month timepoint." They add, "Although questions remain, bariatric arterial embolization remains an exciting, innovative, minimally invasive procedure with the potential to play a significant role in the treatment of the patient with obesity."

Keywords: Cardiology, Weight Loss, Body Mass Index, Global Health, Ulcer, Follow-Up Studies, Intention to Treat Analysis, Obesity, Nausea, Vomiting, Embolization, Therapeutic, Endoscopy, Bariatrics

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