Ali Kordzadeh1,2, Bruno Lorenzi3, Muhammad A Hanif4, Alexandros Charalabopoulos3. 1. Department of Vascular, Endovascular and Renal Access, Mid Essex Hospitals Services NHS Trust, Broomfield, UK. Alikordzadeh@gmail.com. 2. Broomfield Hospital, Essex, CM1 7ET, UK. Alikordzadeh@gmail.com. 3. Department of General and Upper Gastrointestinal Surgery, Regional Oesophagogastric Centre, Mid Essex Hospitals Services NHS Trust, Broomfield, UK. 4. Department of Interventional Radiology, Mid Essex Hospitals Services NHS Trust, Broomfield, UK.
Abstract
BACKGROUND: Endovascular left gastric artery (LGA) embolisation has gained significant attention in the treatment of obesity/morbid obesity and reduction of ghrelin. The objective of this systematic review is to evaluate the recent literature, strengths, limitations and practical aspects of this new procedure in combination with its physiological and anatomical paradigm. METHODS: A systematic electronic search of literature from 1966 to June 2017 in Medline, CINHAL, Embase, Scopus and Cochrane library in English language and adult subjects was conducted. This search was conducted in accordance with Preferred Reporting in Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality assessment of the articles was performed, using Oxford critical appraisal skills programme (CASP), and their recommendation for practice was examined through National Institute for health Care Excellence (NICE). Inter-related reliability (Cronbach's Alpha) was assessed between the two independent reviewers. RESULTS: A total of n = 62 individuals were subjected to LGA embolisation. At 1-3 months, 7-11% and, at 12 months, 2% weight reduction was associated with ghrelin concentration reduction of 36% at 6 months. There was Haemoglobin A1c reduction (7.4 to 6.3%) and improved quality of life (SF-36 questionnaire) at 6 months (9.5 points) (range, 3.2-17.2). Despite immediate epigastric pain and mucosal ulceration, no long-term adverse outcome was identified. The overall length of stay was 2-3 days. CONCLUSIONS: The outcome of this review (level of evidence 3) suggests LGA embolisation is feasible and effective and perhaps a safe procedure in the treatment of obesity and reduction of ghrelin. However, further trials are highly advocated.
BACKGROUND:Endovascular left gastric artery (LGA) embolisation has gained significant attention in the treatment of obesity/morbid obesity and reduction of ghrelin. The objective of this systematic review is to evaluate the recent literature, strengths, limitations and practical aspects of this new procedure in combination with its physiological and anatomical paradigm. METHODS: A systematic electronic search of literature from 1966 to June 2017 in Medline, CINHAL, Embase, Scopus and Cochrane library in English language and adult subjects was conducted. This search was conducted in accordance with Preferred Reporting in Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality assessment of the articles was performed, using Oxford critical appraisal skills programme (CASP), and their recommendation for practice was examined through National Institute for health Care Excellence (NICE). Inter-related reliability (Cronbach's Alpha) was assessed between the two independent reviewers. RESULTS: A total of n = 62 individuals were subjected to LGA embolisation. At 1-3 months, 7-11% and, at 12 months, 2% weight reduction was associated with ghrelin concentration reduction of 36% at 6 months. There was Haemoglobin A1c reduction (7.4 to 6.3%) and improved quality of life (SF-36 questionnaire) at 6 months (9.5 points) (range, 3.2-17.2). Despite immediate epigastric pain and mucosal ulceration, no long-term adverse outcome was identified. The overall length of stay was 2-3 days. CONCLUSIONS: The outcome of this review (level of evidence 3) suggests LGA embolisation is feasible and effective and perhaps a safe procedure in the treatment of obesity and reduction of ghrelin. However, further trials are highly advocated.
Authors: Piotr Kalinowski; Rafał Paluszkiewicz; Tadeusz Wróblewski; Piotr Remiszewski; Mariusz Grodzicki; Zbigniew Bartoszewicz; Marek Krawczyk Journal: Surg Obes Relat Dis Date: 2016-08-18 Impact factor: 4.734