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The embolization of the left gastric artery, a new interventional procedure used to treat obesity, results in the loss of fat and muscle, according to a new study presented today at the meeting annual meeting of the North American Radiological Society (RSNA). The researchers said the loss of muscle mass is worrisome and stresses the importance of proper nutritional counseling after the procedure.
Obesity is a major health problem worldwide, linked to serious diseases such as heart disease, cancer and diabetes. First-line treatments such as diet and exercise often do not work, which leads many patients to opt for gastric bypass surgery. Surgery, which reduces the size of the stomach, has been shown to be effective in treating obesity, but involves significant costs and potential complications.
Currently undergoing clinical study, embolization of the left gastric artery is a less invasive option in surgery. During the procedure, microscopic beads are injected under imaging control into the artery feeding the blood into the stomach. Pearls block blood flow into the stomach and reduce the production of ghrelin, a hormone that stimulates hunger. Early studies have shown that embolization is effective in helping people lose weight, but information lacks on how this could alter the muscle and fat composition of a patient.
"Many researches have been devoted to the effectiveness of gastric artery embolization for weight loss," said lead author Edwin A. Takahashi, MD, Vascular and Interventional Radiology Fellow at the Mayo Clinic in Rochester, Minnesota. "However, there is no data on what contributes to weight loss, whether or not patients lose fat, either muscle mass or a combination of both."
To learn more, Dr. Takahashi and his colleagues studied CT scans of 16 overweight or obese patients who had embolized the left gastric artery to treat gastrointestinal bleeding. CT scanners, when used with special software, measure body composition based on different tissue densities such as fat and muscle.
The analyzes were done before and about 1.5 months after the procedure. The results were compared to those of a control group of 16 ambulatory patients who did not have embolization of the left gastric artery, but underwent a CT scan at two different times for nonspecific abdominal pain.
All 16 individuals lost a lot of weight after embolization, losing an average of 6.4% of their weight in 1.5 months. The body mass index, a measure of body weight in relation to the size of a person, decreased by 6.3%.
Although weight loss was not surprising to researchers, changes in body composition have been. The skeletal muscle index, a measure of the amount of muscle that connects to the skeleton and helps move limbs, decreased by 6.8%. Skeletal muscle is important for health and its loss can impair physical function and metabolism and increase the risk of injury.
"The significant decrease in the amount of skeletal muscle highlights the fact that patients who undergo this procedure are at risk of losing muscle mass and need to be managed accordingly after the procedure," said Dr. Takahashi. "We need to make sure that they receive adequate nutrition to minimize the amount of muscle tissue that they lose."
Patients have also lost a significant amount of body fat. Their overall body fat index decreased by an average of 3.7%. However, most of the fat loss was subcutaneous or directly under the skin. Visceral fat, the most dangerous fat surrounding organs and associated with serious health problems such as heart disease and diabetes, has not decreased significantly during follow-up.
The researchers plan to expand their studies in the future to people who undergo embolization as a treatment for obesity.
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