title: Endoscopic visceral fat removal as therapy for obesity and metabolic syndrome: a sham-controlled pilot study (with video).
abstract: BACKGROUND
  Increased visceral adiposity is a key feature of obesity and metabolic syndrome. Previous studies have generated controversial results regarding visceral fat (VF) removal as a therapy for obesity and metabolic syndrome.
  
  
  OBJECTIVE
  To study the effect of surgical VF removal on metabolic profiles in a mouse model of diet-induced obesity and metabolic syndrome and to evaluate for the first time the feasibility of endoscopic omentectomy using natural orifice transluminal endoscopic surgery (NOTES) technique as treatment for obesity and metabolic syndrome in a feline model.
  
  
  METHODS
  The Johns Hopkins Hospital.
  
  
  METHODS
  Sham-controlled study in a mouse model of metabolic syndrome and then pilot endoscopic sham-controlled study in cats.
  
  
  METHODS
  Partial or total surgical VF removal was performed in a high-fat diet-induced mouse model of obesity and metabolic syndrome, followed by measurements of metabolic profiles, and endoscopic omentectomy was performed in a feline model using the NOTES approach.
  
  
  METHODS
  Weight loss and metabolic profiles.
  
  
  RESULTS
  In a mouse model of obesity, total but not partial VF removal significantly improved obesity and metabolic syndrome, including insulin resistance and hepatic steatosis (all P < .05 vs sham surgery). The improved metabolic syndrome was associated with significantly decreased inflammatory cytokines. In a feline model, endoscopic omentectomy was feasible and safe and resulted in a net weight loss compared with sham surgery (-387 ± 437 g vs 233 ± 351 g, P = .1, respectively).
  
  
  CONCLUSIONS
  Animal experiments.
  
  
  CONCLUSIONS
  Endoscopic omentectomy is safe and feasible and has the potential to treat obesity and metabolic syndrome. Near-total VF removal is required to achieve net weight loss and improvement of metabolic syndrome.
authors.affiliation: The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Lu
authors.initials: L
authors.lastname: Xia
authors.forename: Jing
authors.initials: J
authors.lastname: Hua
authors.forename: Xavier
authors.initials: X
authors.lastname: Dray
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.forename: Shuwen
authors.initials: S
authors.lastname: Liang
authors.forename: Yong-Sik
authors.initials: YS
authors.lastname: Kim
authors.forename: Cristina
authors.initials: C
authors.lastname: Jimeno-Ayllon
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Li
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000818:Animals; D002415:Cats; D005234:Fatty Liver / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000503:physiopathology / Q000601:surgery*; D051379:Mice; D008810:Mice, Inbred C57BL; D057605:Natural Orifice Endoscopic Surgery; D009765:Obesity / Q000503:physiopathology / Q000601:surgery*; D009852:Omentum / Q000601:surgery*; D010865:Pilot Projects; D014781:Viscera / Q000601:surgery*; D015431:Weight Loss