The GAMMA concept (gastrointestinal activity manipulation to modulate appetite) preliminary proofs of the concept of local vibrational gastric mechanical stimulation.
Endoscopy
Gastric stimulation
Obesity
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
29
05
2019
accepted:
19
12
2019
pubmed:
8
1
2020
medline:
29
5
2021
entrez:
8
1
2020
Statut:
ppublish
Résumé
Mechanical stimulation of the stretch receptors of the gastric wall can simulate the presence of indigested food leading to reduced food intake. We report the preliminary experimental results of an innovative concept of localized mechanical gastric stimulation. In a first survival study, a biocompatible bulking agent was injected either in the greater curvature (n = 8) or in the cardia wall (n = 8) of Wistar rats. Six animals served as sham. Changes of bulking volume, leptin levels and weight gain were monitored for 3 months. In a second acute study, a micro-motor (n = 10; MM) or a size-paired inactive device (n = 10; ID) where applied on the cardia, while 10 additional rats served as sham. Serum ghrelin and leptin were measured at baseline and every hour (T0-T1-T2-T3), during 3 h. In a third study, 24 implants of various shapes and sizes were introduced into the gastric subserosa of 6 Yucatan pigs. Monthly CT scans and gastroscopies were done for 6 months. Weight gain in the CW group was significant lower after 2 weeks and 3 months when compared to the shame and GC (p = 0.01/p = 0.01 and p = 0.048/p = 0.038 respectively). Significant lower increase of leptin production occurred at 2 weeks (p = 0.01) and 3 months (p = 0.008) in CW vs. SG. In the MM group significant reduction of the serum ghrelin was seen after 3 h. Leptin was significantly increased in both MM and ID groups after 3 h, while it was significantly reduced in sham rats. The global device retention was 43.5%. Devices with lower profile and with a biocompatible coating remained more likely in place without complications. Gastric mechanical stimulation induced a reduced weight gain and hormonal changes. Low profile and coated devices inserted within the gastric wall are more likely to be integrated.
Sections du résumé
BACKGROUND
Mechanical stimulation of the stretch receptors of the gastric wall can simulate the presence of indigested food leading to reduced food intake. We report the preliminary experimental results of an innovative concept of localized mechanical gastric stimulation.
METHODS
In a first survival study, a biocompatible bulking agent was injected either in the greater curvature (n = 8) or in the cardia wall (n = 8) of Wistar rats. Six animals served as sham. Changes of bulking volume, leptin levels and weight gain were monitored for 3 months. In a second acute study, a micro-motor (n = 10; MM) or a size-paired inactive device (n = 10; ID) where applied on the cardia, while 10 additional rats served as sham. Serum ghrelin and leptin were measured at baseline and every hour (T0-T1-T2-T3), during 3 h. In a third study, 24 implants of various shapes and sizes were introduced into the gastric subserosa of 6 Yucatan pigs. Monthly CT scans and gastroscopies were done for 6 months.
RESULTS
Weight gain in the CW group was significant lower after 2 weeks and 3 months when compared to the shame and GC (p = 0.01/p = 0.01 and p = 0.048/p = 0.038 respectively). Significant lower increase of leptin production occurred at 2 weeks (p = 0.01) and 3 months (p = 0.008) in CW vs. SG. In the MM group significant reduction of the serum ghrelin was seen after 3 h. Leptin was significantly increased in both MM and ID groups after 3 h, while it was significantly reduced in sham rats. The global device retention was 43.5%. Devices with lower profile and with a biocompatible coating remained more likely in place without complications.
CONCLUSIONS
Gastric mechanical stimulation induced a reduced weight gain and hormonal changes. Low profile and coated devices inserted within the gastric wall are more likely to be integrated.
Identifiants
pubmed: 31907661
doi: 10.1007/s00464-019-07325-5
pii: 10.1007/s00464-019-07325-5
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
5346-5353Références
Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH (1999) The disease burden associated with overweight and obesity. JAMA 282:1523–1529
doi: 10.1001/jama.282.16.1523
Pop R, Kong SH, Langlois A, Marchegiani F, Shlomovitz E, Legner A, Bietiger W, Pinget M, Beaujeux R, Mutter D, Marescaux J, Diana M (2019) Gastrointestinal hormones manipulation to counteract metabolic syndrome using duodenal targeted embolization. Surg Innov 26:280–292
doi: 10.1177/1553350619838098
Abdeen G, le Roux CW (2015) Mechanism underlying the weight loss and complications of Roux-en-Y gastric bypass. Review. Obes Surg. https://doi.org/10.1007/s11695-015-1945-7
doi: 10.1007/s11695-015-1945-7
Rashti F, Gupta E, Ebrahimi S, Shope TR, Koch TR, Gostout CJ (2014) Development of minimally invasive techniques for management of medically-complicated obesity. World J Gastroenterol 20:13424–13445
doi: 10.3748/wjg.v20.i37.13424
Weiss R (2008) Devices for the treatment of obesity: will understanding the physiology of satiety unravel new targets for intervention? J Diab Sci Technol 2:501–508
doi: 10.1177/193229680800200323
Lu X, Guo X, Mattar SG, Navia JA, Kassab GS (2010) Distension-induced gastric contraction is attenuated in an experimental model of gastric restraint. Obes Surg 20:1544–1551
doi: 10.1007/s11695-010-0240-x
Cha R, Marescaux J, Diana M (2014) Updates on gastric electrical stimulation to treat obesity: systematic review and future perspectives. World J Gastrointest Endosc 6:419–431
doi: 10.4253/wjge.v6.i9.419
Hasler WL (2009) Methods of gastric electrical stimulation and pacing: a review of their benefits and mechanisms of action in gastroparesis and obesity. Neurogastroenterol Motil 21:229–243
doi: 10.1111/j.1365-2982.2009.01277.x
Kilkenny C, Browne WJ, Cuthill IC, Emerson M, Altman DG (2010) Improving bioscience research reporting: the ARRIVE guidelines for reporting animal research. PLoS Biol 8:e1000412
doi: 10.1371/journal.pbio.1000412
Diana M, Halvax P, Mertz D, Legner A, Brule JM, Robinet E, Mutter D, Pessaux P, Marescaux J (2015) Improving echo-guided procedures using an ultrasound-CT image fusion system. Surg Innov 22:217–222
doi: 10.1177/1553350615577483
Arepally A, Barnett BP, Patel TH, Howland V, Boston RC, Kraitchman DL, Malayeri AA (2008) Catheter-directed gastric artery chemical embolization suppresses systemic ghrelin levels in porcine model. Radiology 249:127–133
doi: 10.1148/radiol.2491071232
Fernandes M, Atallah AN, Soares BG, Humberto S, Guimaraes S, Matos D, Monteiro L, Richter B (2007) Intragastric balloon for obesity. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004931.pub2
doi: 10.1002/14651858.CD004931.pub2
Foschi D, Corsi F, Lazzaroni M, Sangaletti O, Riva P, La Tartara G, Bevilacqua M, Osio M, Alciati A, Bianchi Porro G, Trabucchi E (2007) Treatment of morbid obesity by intraparietogastric administration of botulinum toxin: a randomized, double-blind, controlled study. Int J Obes 31:707–712
doi: 10.1038/sj.ijo.0803451
Weiss CR, Kathait AS (2017) Bariatric embolization: a new and effective option for the obese patient? Expert Rev Gastroenterol Hepatol 11:293–302
doi: 10.1080/17474124.2017.1294060
Bawudun D, Xing Y, Liu WY, Huang YJ, Ren WX, Ma M, Xu XD, Teng GJ (2012) Ghrelin suppression and fat loss after left gastric artery embolization in canine model. Cardiovasc Intervent Radiol 35:1460–1466
doi: 10.1007/s00270-012-0362-8
Diana M, Pop R, Beaujeux R, Dallemagne B, Halvax P, Schlagowski I, Liu YY, Diemunsch P, Geny B, Lindner V, Marescaux J (2015) Embolization of arterial gastric supply in obesity (EMBARGO): an endovascular approach in the management of morbid obesity. proof of the concept in the porcine model. Obes Surg 25:550–558
doi: 10.1007/s11695-014-1535-0
Diana M, Halvax P, Pop R, Schlagowski I, Bour G, Liu YY, Legner A, Diemunsch P, Geny B, Dallemagne B, Beaujeux R, Demartines N, Marescaux J (2015) Gastric supply manipulation to modulate ghrelin production and enhance vascularization to the cardia: proof of the concept in a porcine model. Surg Innov 22:5–14
doi: 10.1177/1553350614552734
Kipshidze N, Archvadze A, Bertog S, Leon MB, Sievert H (2015) Endovascular bariatrics: first in humans study of gastric artery embolization for weight loss. JACC Cardiovasc Interv 8:1641–1644
doi: 10.1016/j.jcin.2015.07.016
Weiss CR, Akinwande O, Paudel K, Cheskin LJ, Holly B, Hong K, Fischman AM, Patel RS, Shin EJ, Steele KE, Moran TH, Kaiser K, Park A, Shade DM, Kraitchman DL, Arepally A (2017) Clinical safety of bariatric arterial embolization: preliminary results of the BEAT obesity trial. Radiology 283:598–608
doi: 10.1148/radiol.2016160914
Chen J (2004) Mechanisms of action of the implantable gastric stimulator for obesity. Obes Surg 14(Suppl 1):S28–32
doi: 10.1007/BF03342135
Horbach T, Thalheimer A, Seyfried F, Eschenbacher F, Schuhmann P, Meyer G (2015) abiliti closed-loop gastric electrical stimulation system for treatment of obesity: clinical results with a 27-month follow-up. Obes Surg 25:1779–1787
doi: 10.1007/s11695-015-1620-z
Anton K, Rahman T, Bhanushali A, Patel AA (2016) Bariatric left gastric artery embolization for the treatment of obesity: a review of gut hormone involvement in energy homeostasis. AJR Am J Roentgenol 206:202–210
doi: 10.2214/AJR.15.14331
Cigaina V, Hirschberg AL (2003) Gastric pacing for morbid obesity: plasma levels of gastrointestinal peptides and leptin. Obes Res 11:1456–1462
doi: 10.1038/oby.2003.195
van Helden DF, Laver DR, Holdsworth J, Imtiaz MS (2010) Generation and propagation of gastric slow waves. Clin Exp Pharmacol Physiol 37:516–524
doi: 10.1111/j.1440-1681.2009.05331.x
Sallam HS, Oliveira HM, Liu S, Chen JD (2010) Mechanisms of burn-induced impairment in gastric slow waves and emptying in rats. Am J Physiol Regul Integr Comp Physiol 299:R298–305
doi: 10.1152/ajpregu.00135.2010