Bariatric Embolizations May Be a Safe Alternative to Gastric Bypass Surgery

by Global Embolization
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Global Embolization Interviews Dr. Aravind Arepally.

A new study which will be starting in July 2014 will determine if bariatric embolization may be a safe and viable option to traditional gastric bypass surgery for treating obesity, type-2 diabetes as well as other...

health problems. Interventional radiologist Aravind Arepally, MD, who is with Piedmont Healthcare, Atlanta, Georgia, along with investigators at Johns Hopkins Medical Center, will be conducting a phase 1 study with 5 patients.  Until now, only a small amount of human clinical data has been reported.

“With bariatric embolization we are creating a minimally-invasive alternative approach to bariatric surgery which does not involve rerouting of the gut.  Bariatric surgery is a major surgery and can be expensive,” said Dr. Arepally. “We are trying to develop an image-guided minimally-invasive alternative procedure to targeted obesity.  The animal data are extremely promising and the clinical data will now be coming shortly.”
 
He said animal studies suggest that bariatric embolization can affect GLP-1, ghrelin and insulin levels.  Dr. Arepally said that often it is the changes in these hormones that can correct type-2 diabetes with bariatric surgery even before any significant weight loss occurs. Approximately 200,000 people have bariatric surgery every year to lose weight.  Most of them are significantly overweight, often as much as 100 pounds above their ideal weight. There are several types of bariatric surgery, which either limit the amount of food the stomach can hold or bypass part of the small intestine, limiting the calories the body can absorb.
 
Bariatric embolization offers the promise of a less invasive, outpatient procedure. In addition, Dr. Arepally said it may make allow for some patients to benefit who were ineligible for traditional bariatric surgery.  “If proven to work, this would have an enormous impact on health care costs,” explained Dr. Arepally.  “If we can create a lower cost and safer alternative to bariatric surgery to address obesity, this would have a significant long-term healthcare impact.”
 
Dr. Arepally, who spoke on bariatric surgery  at GEST 2014 (Global Embolization Symposium and Technologies, May 1-4), said the clinical trial now underway involves a technique that is similar to a heart catheterization but the therapy targets the  functionality of specific portions of the stomach.  Bariatric embolization works by eliminating flow to specific portions of the stomach and thus has an impact on the stomach’s ability to produce hormones that drive hunger and possibility affects hormones such as GLP-1, which is associated with diabetes.
 
“The procedure is somewhat analogous to a heart catheterization and could take 1-2 hours.  Basically, we are reducing flow to targeted areas of the stomach to affect hormonal production linked to diabetes and obesity,” said Dr. Arepally.
 
He said since 1985 only two bariatric devices have been approved in the U.S.   Both of the devices are based on restrictive mechanisms (Adjustable gastric banding, Lap-Bawl, Allergan and REALIZE Adjustable Gastric Band, Ethicon Endo-Surgery).
 
Recently, studies have also suggested that bariatric surgery could be associated with lower cancer mortality among women. Researchers at the University of California San Diego have found that women who undergo bariatric surgery to lose weight may have up to a 70% lower risk of uterine cancer and an even lower risk if they keep their weight off.  The findings from the study, which were presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer in Tampa, Florida, March 22-25, 2014, suggest that obesity may be modifiable risk factor related to the development of endometrial cancer.
 
The study suggests that after women had bariatric surgery their risk of uterine cancer plummeted and became the same or perhaps even a little less than in women who were not obese.  The researchers report that obesity is the second leading cause of preventable death in the U. S. and the findings add to the growing evidence that reducing obesity reduces cancer.

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