title: Bariatric Embolization: Pilot Study on the Impact of Gastroprotective Agents and Arterial Distribution on Ulceration Risk and Efficacy in a Porcine Model.
abstract: OBJECTIVE
  To assess whether the number of fundal arteries embolized and use of gastroprotective agents have an impact on ghrelin suppression and gastric ulceration rates.
  
  
  METHODS
  Twenty-two healthy, growing swine (mean, 38.4 kg; range, 30.3-47.0 kg) were evaluated. Six control swine underwent a sham procedure. Gastric embolization was performed by the infusion of 40-µm microspheres selectively into some or all gastric arteries supplying the gastric fundus. In group 1, 6 swine underwent embolization of all 4 arteries to the gastric fundus. In group 2, 5 swine underwent embolization of 2 gastric fundal arteries. In group 3, 5 swine underwent embolization of 1 gastric fundal artery. Animals in groups 2 and 3 were treated with gastroprotective agents (sucralfate and omeprazole). Weight and fasting plasma ghrelin levels were analyzed at baseline and at week 4. Upon animal euthanasia, gross analysis was performed for identification of ulcers.
  
  
  RESULTS
  Only group 1 animals exhibited changes in serum ghrelin levels that rendered them significantly lower than those in control animals (P = .049). Group 3 animals exhibited marked elevations in serum ghrelin levels compared with control animals (P = .001). Gross pathologic evaluation revealed 0 ulcers in the control animals, 3 ulcers (50%) in group 1, 2 ulcers (40%) in group 2, and 2 ulcers (40%) in group 3.
  
  
  CONCLUSIONS
  Administration of gastroprotective agents and embolization of fewer arteries to the gastric fundus did not prevent gastric ulceration in treated animals. Only animals that underwent embolization of all gastric arteries exhibited significant decreases in serum ghrelin levels.
authors.affiliation: Division of Interventional Radiology, Prescott Radiologists, Prescott, Arizona.
authors.forename: Ben E
authors.initials: BE
authors.lastname: Paxton
authors.affiliation: Division of Interventional Radiology, Piedmont Healthcare, Atlanta, Georgia.
authors.forename: Aravind
authors.initials: A
authors.lastname: Arepally
authors.affiliation: Department of Pathology Box 3808, 2301 Erwin Rd., Durham, NC 27710. Electronic address: charles.kim@duke.edu.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Alley
authors.affiliation: Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2301 Erwin Rd., Durham, NC 27710.
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Kim
mesh_terms: D000792:Angiography; D000818:Animals; D000897:Anti-Ulcer Agents; D001158:Arteries / Q000000981:diagnostic imaging; D015415:Biomarkers / Q000097:blood; D019610:Cytoprotection; D015536:Down-Regulation; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005748:Gastric Fundus / Q000098:blood supply* / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D005753:Gastric Mucosa / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D054439:Ghrelin / Q000097:blood; D023421:Models, Animal; D009853:Omeprazole / Q000494:pharmacology*; D010865:Pilot Projects; D054328:Proton Pump Inhibitors / Q000494:pharmacology*; D013276:Stomach Ulcer / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D013392:Sucralfate / Q000494:pharmacology*; D034421:Sus scrofa
chemical_list: D000897:Anti-Ulcer Agents; D015415:Biomarkers; D054439:Ghrelin; D054328:Proton Pump Inhibitors; D013392:Sucralfate; D009853:Omeprazole