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Could a procedure alter hunger and cure obesity?

By Melissa Healy/New York A medical procedure that treats bleeding in the upper gastrointestinal tract has an unexpected - and, for some patients, quite welcome - side effect: It makes them lose weight. That procedure, called left gastric artery embolisation, may just be the next big thing in the fight against obesity.

And as a new study demonstrates, it does seem to work.

In gastric artery embolisation, an interventional radiologist threads a catheter up (or down, depending on her entry point) to the left gastric artery and deposits a slew of tiny beads to reduce the flow of blood to the gastric fundus, the upper part of the stomach. With its blood supply limited, scientists believe that the upper stomach area cuts back its production of the hormone ghrelin, which is the stomach's signal that it's empty and needs filling.

Along with cells in the pancreas, the cells lining the fundus of the stomach are the body's principal suppliers of the powerful hunger-signalling peptide, ghrelin. In recent years, physicians have observed that patients who had the procedures done tended to lose weight afterwards; as evidence of ghrelin's role in appetite mounted, some began to surmise that the weight loss was the result of reduced ghrelin circulating in these patients' bloodstreams following the procedure.

At the annual meeting of the Radiological Society of North America, a team of researchers set out to test whether physicians' observations were indeed right. They combed electronic medical records looking for patients who had undergone a left gastric embolisation procedure to stanch gastric haemorrhage, and for a comparison group of patients who had undergone another embolisation procedure of a different artery for the same complaint. Their subjects had to have had their weight measured within two weeks prior to the procedures, and within three months after.

In all, they compared 15 patients who had embolisation of the left gastric artery and 18 patients who had had an embolisation procedure elsewhere. The team was led by Massachusetts General Hospital radiologist Rahmi Oklu, who presented the study at the RSNA meeting. Dr Oklu is a liver cancer expert, and the procedure is also widely used to treat the side effects of treatment for advanced liver cancer.

Compared with those who had embolisation of a different artery, patients who had their left gastric artery blocked dropped from an average weight of 189.1 to 174.5 pounds, a 7.9% decrease in body weight. Those whose embolisation targeted other vessels went from an average weight of 164.7 to 162.8 pounds, a 1.2% loss of body weight.

Left gastric artery embolisation is considered a one-day procedure - a far simpler undertaking than most bariatric surgery. Only much more research will tell whether the weight loss it induces is, in fact, a result of reduced ghrelin production, and whether the body over time compensates for the changes the embolisation procedure brings in its wake. The procedure's safety for patients who are healthy but obese is also still far from established.

"These findings may lead to a role for the interventional radiologist in the treatment of obesity," Oklu told his colleagues. - Los Angeles Times

Gulf Times Newspaper 2013

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Publication:Gulf Times (Doha, Qatar)
Date:Nov 22, 2013
Words:535
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