Clifford R. Weiss MD
Bariatric Embolization: Fighting Obesity One Bead at a Time!
(Montag, 16.50 Uhr, Schinkelsaal)
Approximately 127 million (65%) Americans are overweight, obese, or morbidly obese, the rate of morbid obesity (BMI ≥ 40) is increasing rapidly. Obesity negatively affects general health and has been attributed to an increasing incidence of diabetes, heart disease, vascular disease, joint stress, lumbar spine disorders, liver and biliary disease, and various cancers. Despite the health care crisis surrounding obesity, currently there are no image-guided interventions to address obesity and therefore, no percutaneous alternatives to current surgical techniques. Although surgical approaches are available for patients, the success rates are variable and the procedures are highly invasive (often requiring reconstruction of bowel), very costly, and can have significant complications.
Over the last decade, there has been a growing understanding of the role of the stomach as an endocrine organ that is critically involved in the maintenance of energy homeostasis. Although over 40 hormones have been discovered that limit food intake, only ghrelin has been shown to be a very potent orexigenic, i.e., stimulating food intake. Ghrelin-producing cells are predominantly located in the gastric fundus, directly fuel appetite, and induce positive energy balance, resulting in weight gain. Due to the unique nature of this hormone, multiple pharmacological attempts to modulate ghrelin production have been attempted, but there are no clinically viable options available.
One unique approach to affect ghrelin is to take advantage of its production in a unique anatomic localization ― the gastric fundus. Our group has developed a percutaneous, transvascular, minimally invasive procedure, Bariatric Arterial Embolization (BAE), which specifically alters the endocrine functionality of the gastric fundus by using targeted delivery of embolic agents into the left gastric artery. Recently, we have shown that therapeutic agents delivered into the gastric artery significantly suppresses ghrelin production and stops weight gain in a large animal model. Currently we are enrolling patients into an FDA approved phase 1-2 clinical trial entitled Bariatric Embolization of the Arteries for Treatment of Obesity (BEAT Obesity). In this lecture I will review the following:
a) An overview of the Obesity Epidemic.
b) A brief introduction to gastric hormones
c) An overview of changes in GI hormones following Bariatric Surgery
d) Review of the Bariatric Embolization concept and a review of the preliminary data.
e) Discuss ongoing / upcoming clinical trials
f) Discuss future concepts and directions
Clifford R. Weiss MD
Division of Vascular and Interventional Radiology, the Johns Hopkins University School of Medicine, Baltimore, MD