title: Bariatric Arterial Embolization with Non-spherical Polyvinyl Alcohol Particles for Ghrelin Suppression in a Swine Model.
abstract: OBJECTIVE
  To evaluate the effect of bariatric arterial embolization (BAE) with non-spherical polyvinyl alcohol (PVA) particles on systemic ghrelin levels, weight change, and gastric ulceration risk in a swine model.
  
  
  METHODS
  From March 2014 to February 2015, ten healthy swine were used in the study (mean weight 31.5 kg; range 24.0-41.5 kg). The animals were randomly assigned to two groups: the embolized group (n = 5) in which BAE was performed and the control group (n = 5). In the embolized group, BAE was performed by selectively infusing 150-250 or 50-150 μm PVA into the gastric arteries that supplied the fundus of the stomach. In the control group, a sham procedure was performed with saline infusion. Plasma ghrelin levels were prospectively obtained at baseline and every 2 weeks thereafter. Endoscopy was performed 3 weeks after BAE to see whether any gastric ulcer occurred. To determine the durability of the occluded arteries, repeated celiac trunk angiography was performed 8 weeks after BAE. Then, all the swine were killed and necropsies were performed.
  
  
  RESULTS
  The mean post-procedure ghrelin value decreased by 370.0 pg/mL in the embolized group at week 3 (mean 536.0 ± 334.3 pg/mL) and week 5 (mean 515.0 ± 150.0 pg/mL, p < 0.05) relative to baseline (880.0 ± 559.5 pg/mL), respectively, but ghrelin levels were not significantly decreased between the embolized and control groups. There was a significant body weight change as follows: 35.1 ± 9.5 to 46.6 ± 15.7 kg and 31.8 ± 5.8 to 41.2 ± 6.6 kg at baseline and endpoint in the control and embolized groups, respectively (p < 0.05). However, the difference between groups was not significant at endpoint. In the embolized group, ulcerations were identified in three animals (60%) and the recanalization of the embolized arteries was noted on follow-up angiography in three animals (60%), respectively.
  
  
  CONCLUSIONS
  BAE with PVA particles can transiently suppress ghrelin levels in embolized animals, but levels are not significantly different compared to controls. Stomach ulcerations were identified in 60% of the embolized animals.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea. mdkim@yuhs.ac.
authors.forename: Man-Deuk
authors.initials: MD
authors.lastname: Kim
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Kichang
authors.initials: K
authors.lastname: Han
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Lailatul
authors.initials: L
authors.lastname: Muqmiroh
authors.affiliation: Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Gyoung Min
authors.initials: GM
authors.lastname: Kim
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Joonho
authors.initials: J
authors.lastname: Kwon
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Park
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Jong Yun
authors.initials: JY
authors.lastname: Won
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Do Yun
authors.initials: DY
authors.lastname: Lee
mesh_terms: D000792:Angiography; D000818:Animals; D049088:Bariatrics; D001835:Body Weight; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005753:Gastric Mucosa / Q000378:metabolism*; D054439:Ghrelin / Q000097:blood*; D023421:Models, Animal; D011142:Polyvinyl Alcohol / Q000008:administration & dosage*; D013270:Stomach / Q000098:blood supply* / Q000000981:diagnostic imaging; D013276:Stomach Ulcer / Q000209:etiology; D013552:Swine
chemical_list: D054439:Ghrelin; D011142:Polyvinyl Alcohol
keywords: Bariatric embolization; Gastric artery embolization; Ghrelin; Obesity; Weight loss