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Bariatric embolization

BEAT: Bariatric embolization feasible for severely obese

Figure 1: Left gastric artery angiography (black arrow) showing fundus of stomach (dashed arrows). (Credit: Radiological Society of North America)
There was mean excess weight loss of 5.9%±2.4 and 9.0%±4.1 at one month and at three months, respectively

The outcomes from the Bariatric Embolization of Arteries for the Treatment of Obesity (BEAT Obesity) study has found that the procedure is feasible and seems to be well tolerated for severely obese patients.The purpose of the study was to perform a pilot prospective clinical trial to evaluate the feasibility, safety, and short-term efficacy of this procedure in patients with severe obesity.

Clifford R Weiss

The study, led by Dr Clifford R Weiss from the Johns Hopkins University School of Medicine in Baltimore, recruited five severely obese patients (four women, one man) who were 31-49 years of age and who had a mean body mass index of 43.8± 2.9 with no clinically important comorbidities.

Transarterial embolization of the gastric fundus with fluoroscopic guidance was performed with 300-500-μm Embosphere microspheres. The primary end point was 30-day adverse events (AEs). The secondary end points included short-term weight loss, serum obesity-related hormone levels, hunger and satiety assessments, and quality of life (QOL) surveys, reported up to three months.

Surefire Medical’s Infusion System

The study used Surefire Medical’s Infusion System, which was designed to deliver therapy with higher embolisation efficiency than a standard microcatheter. The company’s Infusion technology, with its unique expandable anti-reflux tip, was chosen for its ability to:

  • Improve targeting
  • Prevent reflux into healthy, non-target tissue
  • Achieve deeper penetration of the X-Ray visible embolic beads developed for this study
  • The Surefire expandable tip is designed to expand in reverse flow, which is essential in reducing reflux of diagnostic and therapeutic agents to non-target vessels and minimising potential damage to healthy tissue.

Outcomes

The authors note that the left gastric artery, with or without the gastroepiploic artery, was embolized in five patients, with a technical success rate of 100%. There were no major AEs and two minor AEs; subclinical pancreatitis and a mucosal ulcer that had healed by the time of three-month endoscopy. A hospital stay of less than 48 hours for routine supportive care was provided for three patients.

There was mean excess weight loss of 5.9%±2.4 and 9.0%±4.1 at one month and at three months, respectively. Mean change in serum ghrelin was 8.7%±34.7 and -17.5%±29 at one month and one months, respectively. Mean changes in serum glucagon-like peptide 1 and peptide YY were 106.6%±208.5 and 17.8%±54.8 at one month, with a trend toward improvement in QOL parameters.

Hunger/appetite scores decreased in the first two weeks after the procedure and then rose without reaching pre-procedure levels.

“In conclusion, this initial phase of the BEAT Obesity trial demonstrated that bariatric embolization with 300–500-μm calibrated spheres is technically feasible, appears to be well tolerated, and appears to induce short- and intermediate-term weight loss in this small cohort of severely obese patients,” the authors concluded. “As we continue recruitment for the next trial phase, we anticipate that, with a larger study population, the resultant data will further enhance our understanding of the procedure’s long-term safety and efficacy and its potential mechanism of action.”

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