Histopathologic and immunohistochemical sequelae of bariatric embolization in a porcine model.
OBJECTIVE
To evaluate the histopathologic sequelae of bariatric embolization on the gastric mucosa and to correlate with immunohistochemical evaluation of the gastric fundus, antrum, and duodenum.


METHODS
This study was performed on 12 swine stomach and duodenum specimens after necropsy. Of the 12 swine, 6 had previously undergone bariatric embolization of the gastric fundus, and the 6 control swine had undergone a sham procedure with saline. Gross pathologic, histopathologic, and immunohistochemical examinations of the stomach and duodenum were performed. Specifically, mucosal integrity, fibrosis, ghrelin-expressing cells, and gastrin-expressing cells were assessed.


RESULTS
Gross and histopathologic evaluation of treatment animals showed healing or healed mucosal ulcers in 50% of animals, with gastritis in 100% of treatment animals and in five of six control animals. The ghrelin-immunoreactive mean cell density was significantly lower in the gastric fundus in the treated animals compared with control animals (15.3 vs 22.0, P < .01) but similar in the gastric antrum (9.3 vs 14.3, P = .08) and duodenum (8.5 vs 8.6, P = .89). The gastrin-expressing cell density was significantly lower in the antrum of treated animals compared with control animals (82.2 vs 126.4, P = .03). A trend toward increased fibrosis was suggested in the gastric fundus of treated animals compared with controls (P = .07).


CONCLUSIONS
Bariatric embolization resulted in a significant reduction in ghrelin-expressing cells in the gastric fundus without evidence of upregulation of ghrelin-expressing cells in the duodenum. Healing ulcerations in half of treated animals underscores the need for additional refinement of this procedure.
Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710. Electronic address: dr.paxton@gmail.com.
Ben E
BE
Paxton
Department of Pathology, Duke University Medical Center, Box 3808, Durham, NC 27710.
Christopher L
CL
Alley
Department of Pathology, Duke University Medical Center, Box 3808, Durham, NC 27710.
Jennifer H
JH
Crow
Department of Pathology, Duke University Medical Center, Box 3808, Durham, NC 27710.
James
J
Burchette
The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Clifford R
CR
Weiss
The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Dara L
DL
Kraitchman
Department of Radiology, Piedmont Healthcare, Atlanta, Georgia.
Aravind
A
Arepally
Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
Charles Y
CY
Kim
D000818:Animals; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000033:anatomy & histology* / Q000187:drug effects / Q000378:metabolism*; D054439:Ghrelin / Q000378:metabolism*; D006490:Hemostatics / Q000008:administration & dosage*; D013552:Swine; D014018:Tissue Distribution
D054439:Ghrelin; D006490:Hemostatics