Diana Michele, Pop Raoul, Beaujeux Rémy, Dallemagne Bernard, Halvax Peter, Schlagowski Isabel, Liu Yu-Yin, Diemunsch Pierre, Geny Bernard, Lindner Veronique, Marescaux Jacques
University Institute of Image-Guided Surgery, IHU-Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France,
Obes Surg. 2015 Mar;25(3):550-8. doi: 10.1007/s11695-014-1535-0.
Embolization of the left gastric artery (LGA) reduces circulating levels of ghrelin, but might prevent from further obesity surgery, particularly sleeve gastrectomy (SG), since the gastroesophageal junction (GEJ), depending on LGA, would be devascularized. Our aim was to evaluate, in an experimental animal study, an endovascular approach targeting arteries of the gastroepiploic arcade aiming to modulate ghrelin levels and to generate an increased vascular supply of the GEJ to reduce the risks of staple-line leaks after SG.
Seven pigs underwent embolization of both left and right gastroepiploic arteries (LGEA and RGEA) using 500-700-μ microspheres (embolization of arterial gastric supply in obesity (EMBARGO)-alpha). A SG was performed in six pigs 3 weeks after EMBARGO-alpha and on eight controls. Capillary lactates were measured at the cardia and pylorus. Five pigs underwent coiling of RGEA and embolization of LGEA using both coils and 100-300-μ microspheres (EMBARGO-beta). Ghrelin levels were assessed before and once per week after both EMBARGOs. Control celiac trunk angiography was performed at 3 weeks (alpha) and 4 weeks (beta).
No significant ghrelin reduction was obtained with EMBARGO-alpha at 3 weeks when compared to baseline. Significant ghrelin reduction was found 3 weeks (p = 0.0363) and 4 weeks (p = 0.025) after EMBARGO-beta. Post-EMBARGO-alpha animals presented a significantly lower increase in cardia lactates when compared to controls after SG. Control angiography showed a significantly increased fundic vascular network in 5/6 animals after EMBARGO-alpha and in 5/5 after EMBARGO-beta.
EMBARGO is effective to decrease ghrelin production and can enhance the vascular supply of the GEJ, preparing the vascular background for a SG.
胃左动脉（LGA）栓塞可降低胃饥饿素的循环水平，但可能会妨碍进一步的肥胖症手术，尤其是袖状胃切除术（SG），因为依赖于LGA的胃食管交界处（GEJ）会出现血管脱失。我们的目的是在一项实验动物研究中评估一种针对胃网膜动脉弓的血管内方法，旨在调节胃饥饿素水平，并增加GEJ的血管供应，以降低SG后吻合口漏的风险。
7头猪使用500 - 700μm的微球对左右胃网膜动脉（LGEA和RGEA）进行栓塞（肥胖症动脉性胃供血栓塞术（EMBARGO）-α）。在EMBARGO-α术后3周，对6头猪进行了SG手术，并设置了8头对照猪。测量贲门和幽门处的毛细血管乳酸水平。5头猪对RGEA进行弹簧圈栓塞，并使用弹簧圈和100 - 300μm的微球对LGEA进行栓塞（EMBARGO-β）。在两次EMBARGO手术前及术后每周评估一次胃饥饿素水平。在3周（α组）和4周（β组）时进行对照腹腔干血管造影。
与基线相比，EMBARGO-α术后3周胃饥饿素水平未显著降低。EMBARGO-β术后3周（p = 0.0363）和4周（p = 0.025）时胃饥饿素水平显著降低。与SG术后的对照组相比，EMBARGO-α术后的动物贲门乳酸增加明显更低。对照血管造影显示，EMBARGO-α术后6头动物中有5头、EMBARGO-β术后5头动物的胃底血管网络显著增加。
EMBARGO可有效降低胃饥饿素的产生，并可增强GEJ的血管供应，为SG准备血管条件。
