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Published on: November 14, 2020
A Novel Endoscopic Bariatric Procedure: Results of an Experimental Study
Nickolas Kipshidze1,2, Anaka Prakash3, Nodar Kipshidze4,5
1New York Cardiovascular Research, 1726 2nd Ave., Suite 4S, New York, NY, 10028, USA. Nicholas02@msn.com.
Background:
Surgical treatment of obesity is characterized by both early and late complications, and thus, there is a need to develop safe and non-invasive techniques. Ghrelin is an orexigenic hormone produced by the fundus of the stomach, which may represent a novel target for obesity management. Unfortunately, numerous attempts to alter ghrelin levels have failed to present significant clinical results. We describe a novel procedure that involves modifying arterial blood flow to the gastric fundus for limiting plasma ghrelin levels.
Methods:
A gastroscope was advanced into the gastric fundus of 13 healthy Yorkshire swine, and the fundus was clipped under direct visualization to restrict left gastric artery blood flow. Body weights and ghrelin levels were recorded before and once a week for 4 weeks after the procedure.
Results:
Compared to controls, gastroscopic clipping of the fundus decreased plasma ghrelin levels and prevented further weight gain in the 4 weeks of follow-up. Immunohistochemistry and histomorphometry revealed reduced numbers of ghrelin-positive cells in the fundus of experimental animals. We also observed thrombosis in submucosal arteries and submucosal fibrosis. Histological studies demonstrated minimal gastric mucosal injury.
Conclusion:
Gastroscopic clipping of the fundus in an experimental porcine model resulted in sustained weight loss and a reduction in plasma ghrelin levels at 1 month post-procedure, with no adverse events. Further experimental studies in human patients are needed to examine the clinical utility of this procedure and to optimize a technique, which can facilitate adequate weight loss while minimizing the risk of mucosal injury.
Insights
This study shows that restricting blood flow to the stomach fundus in pigs reduced ghrelin levels and prevented weight gain. This novel, minimally invasive technique may offer a new approach to obesity management.
Area of Science:
- Gastroenterology
- Endocrinology
- Bariatric Medicine
Background:
- Obesity treatment requires safe, non-invasive methods due to surgical complications.
- Ghrelin, a stomach-derived orexigenic hormone, is a potential obesity target, but previous interventions have lacked clinical success.
Purpose of the Study:
- To investigate a novel endoscopic technique for obesity management by modifying gastric fundus arterial blood flow to reduce plasma ghrelin levels.
Main Methods:
- A gastroscope was used to clip the gastric fundus in 13 swine, restricting left gastric artery blood flow.
- Body weights and plasma ghrelin levels were monitored weekly for 4 weeks post-procedure.
Main Results:
- Gastroscopic clipping significantly decreased plasma ghrelin levels and prevented weight gain compared to controls.
- Histological analysis showed reduced ghrelin-positive cells, submucosal artery thrombosis, and fibrosis, with minimal mucosal injury.
Conclusions:
- Endoscopic clipping of the gastric fundus in a porcine model achieved sustained weight loss and reduced ghrelin levels without adverse events.
- Further human trials are necessary to assess clinical utility and optimize the technique for safe and effective weight management.
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