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Review
. 2017 Aug:93:134-142.
doi: 10.1016/j.ejrad.2017.05.019. Epub 2017 May 19.

Current and cutting-edge interventions for the treatment of obese patients

Jenanan Vairavamurthy  1 , Lawrence J Cheskin  2 , Dara L Kraitchman  3 , Aravind Arepally  4 , Clifford R Weiss  5
Affiliations
Review

Current and cutting-edge interventions for the treatment of obese patients

Jenanan Vairavamurthy et al. Eur J Radiol. 2017 Aug.

Abstract

The number of people classified as obese, defined by the World Health Organization as having a body mass index ≥30, has been rising since the 1980s. Obesity is associated with comorbidities such as hypertension, diabetes mellitus, and nonalcoholic fatty liver disease. The current treatment paradigm emphasizes lifestyle modifications, including diet and exercise; however this approach produces only modest weight loss for many patients. When lifestyle modifications fail, the current "gold standard" therapy for obesity is bariatric surgery, including Roux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch, and placement of an adjustable gastric band. Though effective, bariatric surgery can have severe short- and long-term complications. To fill the major gap in invasiveness between lifestyle modification and surgery, researchers have been developing pharmacotherapies and minimally invasive endoscopic techniques to treat obesity. Recently, interventional radiologists developed a percutaneous transarterial catheter-directed therapy targeting the hormonal function of the stomach. This review describes the current standard obesity treatments (including diet, exercise, and surgery), as well as newer endoscopic bariatric procedures and pharmacotherapies to help patients lose weight. We present data from two ongoing human trials of a new interventional radiology procedure for weight loss, bariatric embolization.

Keywords: BEAT Obesity; Bariatric surgery; Embolization; Obesity; Weight loss.

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Conflict of interest statement

Conflicts of Interest: The authors do not have any conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Most common bariatric surgical procedures. (a) Adjustable gastric band. (b) Sleeve gastrectomy. (c) Roux-en-Y-gastric bypass. (d) Biliopancreatic diversion with duodenal switch. (Reprinted with permission from Atlas of Metabolic and Weight Loss Surgery, Jones et al. Cine-Med, 2010. Fig. 1. Copyright of the book and illustrations are retained by Cine-Med.)
Fig. 2
Fig. 2
Illustrations of endoscopic bariatric procedures. (a) Space-occupying device. (b) Restrictive procedure. (c) Bypass liner. (d) Aspiration therapy. (e) Gastric stimulation. (f) Transpyloric shuttle. (Reprinted with permission from Neylan, D.T. Dempsey, C.M. Tewksbury, N.N. Williams, K.R. Dumon, Endoscopic treatments of obesity: a comprehensive review, Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery 12(5) (2016) 1108–15. Fig. 1.)
Fig. 3
Fig. 3
Bariatric embolization angiograms from the BEAT Obesity trial. (a) Celiac axis before embolization. Note the normal vascular distribution in the region of the gastric fundus (circle) from the left gastric artery (arrow). (b) Celiac axis angiogram postembolization showing decreased opacification of the distal branches in the region of the gastric fundus (circle) and decreased flow in the left gastric artery (arrow). (c) Selective left gastric artery angiogram. The arrow shows the location of the microcatheter within the distal left gastric artery at the time of embolization. (d) Selective left gastric artery angiogram postembolization showing decreased markedly truncated vessels flow. (e) Selective gastroepiploic artery angiogram showing flow to the gastric fundus. The arrow shows the location of the microcatheter within the distal gastroepiploic artery at the time of embolization. (f) Selective gastroepiploic artery angiogram postembolization showing markedly truncated vessel flow.
See this image and copyright information in PMC

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