SIR 2024
Gastrointestinal Interventions
Imran S. Alam, MS, BS
Medical Student
Royal College of Surgeons Ireland, Ireland
Financial relationships: Full list of relationships is listed on the CME information page.
Hossam A. Zaki, BS
Medical Student
Warren Alpert Medical School of Brown University
Financial relationships: Full list of relationships is listed on the CME information page.
Clifford R. Weiss, MD, FSIR
Professor of Radiology and Biomedical Engineering
The Johns Hopkins Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
1) Educate readers on the various Bariatric IR procedures available to patients and how IR can be crucial in treating obesity 2) Provide extensive descriptions of IR bariatric procedures and their safety and efficacy
Background:
Obesity is a systemic disease characterized by an accumulation of adipose tissue that predisposes individuals to many comorbidities. It is a public health issue affecting millions worldwide. Since 1975, worldwide obesity has nearly tripled, constituting around 9% of the world population {1}. As the prevalence of obesity continually increases, the demand for weight loss interventions has increased.
The first-line approaches to treat obesity are lifestyle changes and pharmacologic therapies. However, bariatric surgery is the most robust treatment for sustained weight loss {2}. This is often invasive, and many patients may not qualify. Bariatric interventional radiology provides an alternative to traditional surgeries. Bariatric artery embolization (BAE), cryo-vagotomy, and yttrium-90 (Y90) transarterial radioembolization (TARE) are all minimally invasive bariatric procedures that can be carried out by IRs to treat obesity {3, 4, 5}.
Clinical Findings/Procedure Details:
BAE: The goal is to induce ischemia in fundal cells of the stomach producing ghrelin, the hormone responsible for stimulating hunger. This exhibit will discuss 1) the pathophysiologic basis of BAE 2) relevant vascular anatomy 3) procedure steps and 4) results from clinical trials and limitations to the procedure.
Cryo-vagotomy: The goal is to cryoablate the vagus nerve to lessen hunger signals to the brain. This exhibit will cover 1) the pathophysiologic basis of cryo-vagotomy, 2) procedural details, 3) results from clinical trials.
Y90 TARE: The goal is to use localized radiation to allow for more precise targeting of ghrelin-producing cells, contrasted to BAE which will induce ischemia instead. This exhibit will cover 1) the pathophysiology of Y90 TARE and the potential for radiation instead of generalized ischemia, 2) relevant vascular anatomy, 3) procedural steps, and 4) results from TARE in porcine models.
Conclusion and/or Teaching Points:
As the prevalence of obesity increases, interventional radiologists should be aware of bariatric IR procedures as an alternative to invasive procedures. This exhibit shows the following points 1) BAE and Cryo-vagotomy are promising safe and effective procedures in treating obesity 2) TARE for treating obesity should be further explored 3) All three procedures provide a promising future in medically managing obesity.