title: A Novel Endoscopic Bariatric Procedure: Results of an Experimental Study.
abstract: Surgical treatment of obesity is characterized by both early and late complications, and thus, there is a need to develop safe and non-invasive techniques. Ghrelin is an orexigenic hormone produced by the fundus of the stomach, which may represent a novel target for obesity management. Unfortunately, numerous attempts to alter ghrelin levels have failed to present significant clinical results. We describe a novel procedure that involves modifying arterial blood flow to the gastric fundus for limiting plasma ghrelin levels.
  
  
  
  A gastroscope was advanced into the gastric fundus of 13 healthy Yorkshire swine, and the fundus was clipped under direct visualization to restrict left gastric artery blood flow. Body weights and ghrelin levels were recorded before and once a week for 4 weeks after the procedure.
  
  
  
  Compared to controls, gastroscopic clipping of the fundus decreased plasma ghrelin levels and prevented further weight gain in the 4 weeks of follow-up. Immunohistochemistry and histomorphometry revealed reduced numbers of ghrelin-positive cells in the fundus of experimental animals. We also observed thrombosis in submucosal arteries and submucosal fibrosis. Histological studies demonstrated minimal gastric mucosal injury.
  
  
  
  Gastroscopic clipping of the fundus in an experimental porcine model resulted in sustained weight loss and a reduction in plasma ghrelin levels at 1 month post-procedure, with no adverse events. Further experimental studies in human patients are needed to examine the clinical utility of this procedure and to optimize a technique, which can facilitate adequate weight loss while minimizing the risk of mucosal injury.
authors.affiliation: New York Cardiovascular Research, 1726 2nd Ave., Suite 4S, New York, NY, 10028, USA. Nicholas02@msn.com.|N. Kipshidze Central University Hospital, 29 Vazha Pshavela Ave, Tbilisi, Georgia. Nicholas02@msn.com.
authors.forename: Nickolas
authors.initials: N
authors.lastname: Kipshidze
authors.affiliation: NJ Medical Health Associates, 1 Journal Square Plz. Ste. 2, Jersey City, NJ, USA.
authors.forename: Anaka
authors.initials: A
authors.lastname: Prakash
authors.affiliation: New York Cardiovascular Research, 1726 2nd Ave., Suite 4S, New York, NY, 10028, USA.|College of Global Public Health, New York University, New York, NY, USA.
authors.forename: Nodar
authors.initials: N
authors.lastname: Kipshidze
authors.affiliation: Tbilisi State Medical University, 7 Mikheli Asatianti St, Tbilisi, Georgia.
authors.forename: David
authors.initials: D
authors.lastname: Chakhunashvili
authors.affiliation: Tbilisi State Medical University, 7 Mikheli Asatianti St, Tbilisi, Georgia.
authors.forename: Zurab
authors.initials: Z
authors.lastname: Kakabadze
mesh_terms: D000818:Animals; D001158:Arteries / Q000601:surgery*; D050110:Bariatric Surgery; D004724:Endoscopy; D005260:Female; D005748:Gastric Fundus / Q000098:blood supply* / Q000601:surgery; D005773:Gastroscopy; D054439:Ghrelin / Q000097:blood*; D008297:Male; D009765:Obesity / Q000097:blood / Q000601:surgery*; D017792:Surgical Stapling; D013552:Swine
chemical_list: D054439:Ghrelin
keywords: Endoscopy; Ghrelin; Left gastric artery; Obesity; Weight loss