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BEAT Obesity

Bariatric embolization shows promise as a treatment for obesity

(Credit: Radiological Society of North America
Bariatric embolization is not proposed as a replacement for bariatric surgery, but as a supplemental method to facilitate weight loss with lifestyle modification

Although bariatric embolization is unlikely to promote weight loss as effectively as bariatric surgery, it is at least as effective as some pharmacotherapies (ie, liraglutide, orlistat, lorcaserin), which induce mean weight loss of 2%–9% (28), according to researchers from the Bariatric Embolization of Arteries for the Treatment of Obesity (BEAT Obesity) trial, who assessed the procedure's effects on 20 severely obese participants over the course of one year.

Bariatric embolization has emerged in recent years as one such option. In the procedure, microscopic spheres are introduced through a catheter into the arteries that supply blood to the stomach. The blocking of the arteries with the beads produces a reduction in blood flow, enough to suppress production of hunger-stimulating hormones but not enough to cause tissue damage.

According to the investigators, an advantage of bariatric embolization is that patients can achieve weight loss similar to that with pharmacotherapy after undergoing one procedure in combination with lifestyle changes, without requiring long-term adherence to scheduled medication doses, which can be difficult for some patients. The study. ‘Bariatric Embolization of Arteries for the Treatment of Obesity (BEAT Obesity) Trial: Results at 1 Year’, was published in the journal Radiology.

For this prospective study, 20 participants (16 women) aged 27–68 years (mean ± standard deviation, 44 years ± 11) with mean BMI of 45±4.1 were enrolled at two institutions from June 2014 to February 2018. Transarterial embolization of the gastric fundus was performed using 300- to 500-µm embolic microspheres.

Primary end points were 30-day adverse events and weight loss at up to 12 months. Secondary end points at up to 12 months included technical feasibility, health-related quality of life (Short Form-36 Health Survey ([SF-36]), impact of weight on quality of life (IWQOL-Lite), and hunger or appetite using a visual assessment scale.

Outcomes

Bariatric embolization was performed successfully for all participants with no major adverse events. Eight participants had a total of 11 minor adverse events. Mean excess weight loss was 8.2% (p<0.001) at one month, 11.5% (p<0.001) at three months, 12.8% (p<0.001) at six months and 11.5% (p<0.001) at 12 months.

From baseline to 12 months, mean SF-36 scores increased (mental component summary, from 46±11 to 50±10, p=0.44; physical component summary, from 46±8.0 to 50±9.3, p=0.15) and mean IWQOL-Lite scores increased from 57±18 to 77±18 (p<0.001). Hunger or appetite decreased for four weeks after embolization and increased thereafter, without reaching pre-embolization levels.

The researchers also saw encouraging signs of metabolic changes in the patients, with decreases in total cholesterol and increases in levels of high-density lipoprotein, the so-called good cholesterol. Tests given to the participants showed that their quality of life improved in the year after the procedure.

"This is a great step forward for this procedure in establishing early feasibility, safety and early efficacy," said study lead author. Dr Clifford R Weiss, from the Johns Hopkins University School of Medicine in Baltimore. "It is fulfilling to all of us to see something that started as an idea develop through about a decade of research and then go all the way to an initial clinical trial."

Weiss credited his co-principal investigators, Dr Aravind Arepally, formerly of Johns Hopkins and currently at Piedmont Healthcare in Atlanta and Dr Aaron M Fischman, of Mount Sinai Hospital in New York City. He also credits veterinarian, Dr Dara L Kraitchman, from Johns Hopkins, who helped lead the animal studies that preceded the clinical trial.

"This is the result of collaborative research, of step-by-step basic and translational science to get to the point where we could do a clinical trial safely," added Weiss. "We had a multidisciplinary team, including interventional radiologists, gastroenterologists, dietitians, psychologists, hormone experts, bariatric surgeons and statisticians, looking at this from all different angles to make sure we were investigating it in a very rigorous and scientific way."

Although the one-year results are encouraging, Weiss emphasized that important research remains. The team has been tracking hormonal changes in the patients and are preparing to release results of that study shortly. They also intend to look at longer-term outcomes and the possible impact of the placebo effect.

If the one-year results are any indication, bariatric embolization has a bright future as a tool in a more personalized approach to the treatment of obesity, a disease increasingly understood to differ from patient to patient.

"The reality is that obesity itself is an individualised disease that requires individualised treatments," explained Weiss. "I see a day when there will be a multidisciplinary obesity clinic where six or seven different practitioners get together to treat the patient. This is already happening at some sites, but they are rare and they need to be more widespread, like multidisciplinary cancer centres."

Figure 1: (a) Distribution of various gastric ulcerations observed during endoscopy 1 week after bariatric embolization. Relative sizes and shapes of ulcers are indicated by sizes and shapes of colored dots on diagram. Each color represents ulcers found on one participant (eg, the three black dots represent ulcers on one partici¬pant).The curved purple line represents a linear ulcer. The ulcer represented as a yellow oval and enclosed by a blue square corresponds to that shown in (b)-(d). (b)-(d) Endoscopic images of the same location in one partici¬pant (48-year-old African American woman with a baseline weight of 127 kg): (b) at baseline, (c) at 2 weeks after embolization (arrow indicates a small, superficial gastric ulcer, measuring 1 cm on the longest axis), and (d) at 3 months after embolization (arrow indicates prior location of the ulcer). Credit: Radiological Society of North America

The researchers reiterated bariatric embolization is not proposed as a replacement for bariatric surgery, but as a supplemental method to facilitate weight loss with lifestyle modification.

“Bariatric embolization is well tolerated and promotes clinically relevant weight loss in adults with severe obesity,” the authors concluded. “It may provide needed assistance to patients who are struggling to succeed in lifestyle modification–based weight loss programmes.”

To access this paper, please click here

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