title: Gastric supply manipulation to modulate ghrelin production and enhance vascularization to the cardia: proof of the concept in a porcine model.
abstract: BACKGROUND
  Selective embolization of the left-gastric artery (LGA) reduces levels of ghrelin and achieves significant short-term weight loss. However, embolization of the LGA would prevent the performance of bariatric procedures because the high-risk leakage area (gastroesophageal junction [GEJ]) would be devascularized.
  
  
  OBJECTIVE
  To assess an alternative vascular approach to the modulation of ghrelin levels and generate a blood flow manipulation, consequently increasing the vascular supply to the GEJ.
  
  
  METHODS
  A total of 6 pigs underwent a laparoscopic clipping of the left gastroepiploic artery. Preoperative and postoperative CT angiographies were performed. Ghrelin levels were assessed perioperatively and then once per week for 3 weeks. Reactive oxygen species (ROS; expressed as ROS/mg of dry weight [DW]), mitochondria respiratory rate, and capillary lactates were assessed before and 1 hour after clipping (T0 and T1) and after 3 weeks of survival (T2), on seromuscular biopsies. A celiac trunk angiography was performed at 3 weeks.
  
  
  RESULTS
  Mean (±standard deviation) ghrelin levels were significantly reduced 1 hour after clipping (1902 ± 307.8 pg/mL vs. 1084 ± 680.0; P = .04) and at 3 weeks (954.5 ± 473.2 pg/mL; P = .01). Mean ROS levels were statistically significantly decreased at the cardia at T2 when compared with T0 (0.018 ± 0.006 mg/DW vs. 0.02957 ± 0.0096 mg/DW; P = .01) and T1 (0.0376 ± 0.008 mg/DW; P = .007). Capillary lactates were significantly decreased after 3 weeks, and the mitochondria respiratory rate remained constant over time at the cardia and pylorus, showing significant regional differences.
  
  
  CONCLUSIONS
  Manipulation of the gastric flow targeting the gastroepiploic arcade induces ghrelin reduction. An endovascular approach is currently under evaluation.
authors.affiliation: IHU Institute for Minimally Invasive Image-Guided Surgery, Strasbourg, France Physiology Institute, Research Unit on oxidative stress and mitochondria (EA 3072), University of Strasbourg, France IRCAD, Institute for Research against Cancer of the Digestive System, Strasbourg, France CHUV, University Hospital of Lausanne, Switzerland michele.diana@ircad.fr.
authors.forename: Michele
authors.initials: M
authors.lastname: Diana
authors.affiliation: IHU Institute for Minimally Invasive Image-Guided Surgery, Strasbourg, France.
authors.forename: Peter
authors.initials: P
authors.lastname: Halvax
authors.affiliation: IHU Institute for Minimally Invasive Image-Guided Surgery, Strasbourg, France.
authors.forename: Raoul
authors.initials: R
authors.lastname: Pop
authors.affiliation: Physiology Institute, Research Unit on oxidative stress and mitochondria (EA 3072), University of Strasbourg, France.
authors.forename: Isabel
authors.initials: I
authors.lastname: Schlagowski
authors.affiliation: IRCAD, Institute for Research against Cancer of the Digestive System, Strasbourg, France.
authors.forename: Gaetan
authors.initials: G
authors.lastname: Bour
authors.affiliation: IRCAD, Institute for Research against Cancer of the Digestive System, Strasbourg, France.
authors.forename: Yu-Yin
authors.initials: YY
authors.lastname: Liu
authors.affiliation: IHU Institute for Minimally Invasive Image-Guided Surgery, Strasbourg, France.
authors.forename: Andras
authors.initials: A
authors.lastname: Legner
authors.affiliation: Department of Anesthesia, University Hospital of Strasbourg, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Diemunsch
authors.affiliation: Physiology Institute, Research Unit on oxidative stress and mitochondria (EA 3072), University of Strasbourg, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Geny
authors.affiliation: IRCAD, Institute for Research against Cancer of the Digestive System, Strasbourg, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Dallemagne
authors.affiliation: IHU Institute for Minimally Invasive Image-Guided Surgery, Strasbourg, France.
authors.forename: Rémy
authors.initials: R
authors.lastname: Beaujeux
authors.affiliation: CHUV, University Hospital of Lausanne, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: IHU Institute for Minimally Invasive Image-Guided Surgery, Strasbourg, France IRCAD, Institute for Research against Cancer of the Digestive System, Strasbourg, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000792:Angiography; D000818:Animals; D002299:Cardia / Q000502:physiology*; D002445:Celiac Artery / Q000000981:diagnostic imaging; D024405:Gastroepiploic Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D054439:Ghrelin / Q000032:analysis / Q000378:metabolism*; D007773:Lactates / Q000097:blood; D008297:Male; D017382:Reactive Oxygen Species / Q000032:analysis; D013270:Stomach / Q000098:blood supply*; D013552:Swine
chemical_list: D054439:Ghrelin; D007773:Lactates; D017382:Reactive Oxygen Species
keywords: bariatric gastric flow manipulation; gastric arteries embolization; ischemic preconditioning