Left Gastric Artery Embolization in Obese, Prediabetic Patients: A Pilot Study

Clinical question
Does HbA1c change after Left Gastric artery embolization (LGAE) in obese, prediabetic patients?

Take away point
At 6 months LGAE significantly decreased HbA1c, BMI and body weight with no major adverse events.

Reference

Left Gastric Artery Embolization in Obese, Prediabetic Patients: A Pilot Study
Zaitoun, Mohamed M.A. et al. Journal of Vascular and Interventional Radiology, Volume 30, Issue 6, 790 - 796

Click here for abstract 

Study design

Single arm, prospective, cohort study of 10 obese prediabetic patients.

Funding Source

No reported funding

Setting
Academic hospital, Cairo University, Egypt.

Figure 2

Left gastric artery angiogram in a 49 year old patient showing normal anatomy (a). Left gastric artery injection shows normal fundal blush supplying the posterior branch (b). The anterior branch of the LGA prior to embolization, shows normal anatomy and fundal blush (c). Post-LGA embolization shows absence of the normal fundal blush.

Summary

Left gastric artery embolization (LGAE) has shown promising results for weight loss in patients with a BMI >40, however glycemic control in pre-diabetic patients with BMI <40 has not been studied. The authors performed a prospective study of 10 obese pre-diabetic patients that underwent LGAE and evaluated weight, BMI, HgA1c and adverse events. 

Patients included in this study were adults that had failed conservative weight loss treatment (exercise, weight loss programs, medications), were not interested in surgical management, had a BMI >30 kg/m2, HbA1c <5.7 and >6.4 and had normal liver, renal and hematological parameters. Patients were excluded if they had chronic diseases, prior bariatric or gastric surgery, peptic ulcer disease or reflux, diabetes or family history of diabetes and pregnancy. 

Patients in this study were not instructed to change their dietary or exercise habits and did not take any medications for glycemic control. Endoscopy was performed pre and 1 month post LGAE and any patients with pre-LGAE abnormalities were excluded. Patients were placed on oral omeprazole and sucralfate for 2 weeks prior to the procedure and 6 weeks after. LGAE of the fundal branches was performed with 300-500 micron Embospheres until 5 beats of stasis was obtained. 

There was 100% technical success, the gastric fundus was always supplied from the LGA, and no major adverse events were experienced. After one week, endoscopic findings were normal. At 6 months all patients showed a reduction in weight, BMI and HgA1c. The mean body weight significantly decreased from 107.4 kg to 98 kg (p<0.0001), BMI significantly decreased from 37.4 to 34.1 (p<0.0001) and HbA1c decreased from 6.1 to 4.7 (p<0.0001). The observed mean percent reduction in weight was 8.9%, 8.8% in BMI and 21.4 % difference in HgA1c.

Commentary

The authors in this study evaluated LGAE in 10 pre-diabetic adult patients with a BMI < 40, which is a cohort that has not been studied before. The findings are encouraging and were able to show that on average at 6 months, HgA1c significantly improved by 21.4%, body weight improved by 8.9% and BMI by 8.8%. Multidisciplinary management of obesity is necessary, and LGAE is proving to be an important element in the control of this epidemic. Diabetes, and its multiple associated co-morbidities, is difficult to control and this study was able to show that LGAE might be a good option when conservative measurements have failed. It is important that all LGAE research be conducted in a multidisciplinary manner, with strict longitudinal follow up, and adequate assessment by all involved physicians, as it was done by the authors of this study.

Post Author
Carlos J. Guevara, MD, FSIR
Assistant Professor of Radiology and Surgery
Department of Radiology, Interventional Radiology Division
Washington University in St. Louis, Mallinckrodt Institute of Radiology,
@CarlosGuevaraIR