Left gastric artery embolization as an alternative for appetite suppression and weight loss in obese patients: an integrative review
DOI:
https://doi.org/10.33448/rsd-v10i2.11629Keywords:
Bariatric surgery; Embolization, therapeutic; Grelin; Obesity; Weight loss.Abstract
Obesity is characterized by the excessive accumulation of body fat at a level that compromises the health of individuals and is associated with the development of chronic diseases. The treatment of obesity consists of diet modification, institution of physical activity and pharmacotherapy followed or not by bariatric surgery. Although surgery has shown positive results in terms of weight loss and reversal of comorbidities, the high cost, invasiveness, risk of mortality and the restriction of the population capable of performing the procedure, encourage research for alternative therapies. Thus, there is embolization of branches of the left gastric artery, in order to promote the suppression of the hormone ghrelin, an endovascular procedure for the treatment of obesity. The purpose of this literature review is to analyze published pre-clinical, clinical and retrospective studies to assess safety, efficacy, side effects, ghrelin levels and the excess weight loss achieved after follow-up over a period. Scientific publications were searched in the PubMed, Medline, CINHAL, Scopus, Cochrane and SCIELO databases from February/1999 to November/2020 and 15 studies were included. We concluded that it is too early to compare the effectiveness of this technique with bariatric surgery, as current reports describe only the experience with a limited number of patients with relatively short follow-up periods. In addition, the variability between these studies is high. Concerns were raised in initial studies about the delay in gastric emptying that can occur after this procedure, needing to be carefully evaluated.
References
Aldawudi, I., Katwal, P. C., Jirjees, S., Htun, Z. M., & Khan, S. (2020). Future of Bariatric Embolization: A Review of Up-to-date Clinical Trials. Cureus, 12(5), e7958. https://doi.org/10.7759/cureus.7958
Allison, D. B., Gadde, K. M., Garvey, W. T., Peterson, C. A., Schwiers, M. L., Najarian, T., Tam, P. Y., Troupin, B., & Day, W. W. (2012). Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring, Md.), 20(2), 330–342. https://doi.org/10.1038/oby.2011.330
Alvarez R, Telem DA. (2018) . Comparative Surgical Outcomes in Bariatric Surgery. In The SAGES Manual of Bariatric Surgery (pp.339-361). EUA: Springer International Publishing. http://dx.doi.org/10.1007/978-3-319-71282-6_29.
Antel, J., & Hebebrand, J. (2012). Weight-reducing side effects of the antiepileptic agents topiramate and zonisamide. Handbook of experimental pharmacology, (209), 433–466. https://doi.org/10.1007/978-3-642-24716-3_20
Anton, K., Rahman, T., Bhanushali, A. B., Nadal, L. L., Pierce, G., & Patel, A. A. (2015, December 3). Weight Loss Following Left Gastric Artery Embolization in a Human Population without Malignancy: A Retrospective Review. Journal of Obesity & Weight Loss Therapy, 1-4. http://dx.doi.org/10.4172/2165-7904.1000285
Apovian C. M. (2016). Naltrexone/bupropion for the treatment of obesity and obesity with Type 2 diabetes. Future cardiology, 12(2), 129–138. https://doi.org/10.2217/fca.15.79
Arepally, A., Barnett, B. P., Montgomery, E., & Patel, T. H. (2007). Catheter-directed gastric artery chemical embolization for modulation of systemic ghrelin levels in a porcine model: initial experience. Radiology, 244(1), 138–143. https://doi.org/10.1148/radiol.2441060790
Arepally, A., Barnett, B. P., Patel, T. H., Howland, V., Boston, R. C., Kraitchman, D. L., & Malayeri, A. A. (2008). Catheter-directed gastric artery chemical embolization suppresses systemic ghrelin levels in porcine model. Radiology, 249(1), 127–133. https://doi.org/10.1148/radiol.2491071232
Aronne, L. J., Wadden, T. A., Peterson, C., Winslow, D., Odeh, S., & Gadde, K. M. (2013). Evaluation of phentermine and topiramate versus phentermine/topiramate extended-release in obese adults. Obesity (Silver Spring, Md.), 21(11), 2163–2171. https://doi.org/10.1002/oby.20584
Aronne, L. J., Wadden, T., Isoldi, K. K., & Woodworth, K. A. (2009). When prevention fails: obesity treatment strategies. The American journal of medicine, 122(4 Suppl 1), S24–S32. https://doi.org/10.1016/j.amjmed.2009.01.005
Bai, Z. B., Qin, Y. L., Deng, G., Zhao, G. F., Zhong, B. Y., & Teng, G. J. (2018). Bariatric Embolization of the Left Gastric Arteries for the Treatment of Obesity: 9-Month Data in 5 Patients. Obesity surgery, 28(4), 907–915. https://doi.org/10.1007/s11695-017-2979-9
Baptista, V., & Wassef, W. (2013). Bariatric procedures: an update on techniques, outcomes and complications. Current opinion in gastroenterology, 29(6), 684–693. https://doi.org/10.1097/MOG.0b013e3283651af2
Bawudun, D., Xing, Y., Liu, W. Y., Huang, Y. J., Ren, W. X., Ma, M., Xu, X. D., & Teng, G. J. (2012). Ghrelin suppression and fat loss after left gastric artery embolization in canine model. Cardiovascular and interventional radiology, 35(6), 1460–1466. https://doi.org/10.1007/s00270-012-0362-8
Bennett, J. M., Mehta, S., & Rhodes, M. (2007). Surgery for morbid obesity. Postgraduate medical journal, 83(975), 8–15. https://doi.org/10.1136/pgmj.2006.048868
Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004). Bariatric surgery: a systematic review and meta-analysis. JAMA, 292(14), 1724–1737. https://doi.org/10.1001/jama.292.14.1724
Campos, J., Ramos, A., Szego, T., Zilberstein, B., Feitosa, H., & Cohen, R. (2016). THE ROLE OF METABOLIC SURGERY FOR PATIENTS WITH OBESITY GRADE I AND TYPE 2 DIABETES NOT CONTROLLED CLINICALLY. Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 29 Suppl 1(Suppl 1), 102–106. https://doi.org/10.1590/0102-6720201600S10025
Cawley, J., & Meyerhoefer, C. (2012). The medical care costs of obesity: an instrumental variables approach. Journal of health economics, 31(1), 219–230. https://doi.org/10.1016/j.jhealeco.2011.10.003
Christian, JG, Tsai, AG, & Bessesen, DH (2010). Interpretando as perdas de peso em estudos de modificação do estilo de vida: usando dados categóricos. Jornal internacional de obesidade (2005) , 34 (1), 207–209. https://doi.org/10.1038/ijo.2009.213
Coutinho, A. K., & Glancey, G. R. (2013). Orlistat, an under-recognised cause of progressive renal impairment. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 28 Suppl 4, iv172–iv174. https://doi.org/10.1093/ndt/gft066
Cummings D. E. (2006). Ghrelin and the short- and long-term regulation of appetite and body weight. Physiology & behavior, 89(1), 71–84. https://doi.org/10.1016/j.physbeh.2006.05.022
Cummings, D. E., & Overduin, J. (2007). Gastrointestinal regulation of food intake. The Journal of clinical investigation, 117(1), 13–23. https://doi.org/10.1172/JCI30227
Cummings, D. E., Purnell, J. Q., Frayo, R. S., Schmidova, K., Wisse, B. E., & Weigle, D. S. (2001). A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes, 50(8), 1714–1719. https://doi.org/10.2337/diabetes.50.8.1714
Cummings, D. E., Weigle, D. S., Frayo, R. S., Breen, P. A., Ma, M. K., Dellinger, E. P., & Purnell, J. Q. (2002). Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. The New England journal of medicine, 346(21), 1623–1630. https://doi.org/10.1056/NEJMoa012908
Elens, S., Roger, T., Elens, M., Rommens, J., Sarafidis, A., Capelluto, E., & Delcour, C. (2019). Gastric Embolization as Treatment for Overweight Patients; Efficacy and Safety. Cardiovascular and interventional radiology, 42(4), 513–519. https://doi.org/10.1007/s00270-018-2130-x
English, P. J., Ghatei, M. A., Malik, I. A., Bloom, S. R., & Wilding, J. P. (2002). Food fails to suppress ghrelin levels in obese humans. The Journal of clinical endocrinology and metabolism, 87(6), 2984. https://doi.org/10.1210/jcem.87.6.8738
Finucane, M. M., Stevens, G. A., Cowan, M. J., Danaei, G., Lin, J. K., Paciorek, C. J., Singh, G. M., Gutierrez, H. R., Lu, Y., Bahalim, A. N., Farzadfar, F., Riley, L. M., Ezzati, M., & Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index) (2011). National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet (London, England), 377(9765), 557–567. https://doi.org/10.1016/S0140-6736(10)62037-5
Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. JAMA, 303(3), 235–241. https://doi.org/10.1001/jama.2009.2014
Fu, Y., & Kraitchman, D. L. (2020). Rationale and Preclinical Data Supporting Bariatric Arterial Embolization. Techniques in vascular and interventional radiology, 23(1), 100656. https://doi.org/10.1016/j.tvir.2020.100656
Fu, Y., Weiss, C. R., Paudel, K., Shin, E. J., Kedziorek, D., Arepally, A., Anders, R. A., & Kraitchman, D. L. (2018). Bariatric Arterial Embolization: Effect of Microsphere Size on the Suppression of Fundal Ghrelin Expression and Weight Change in a Swine Model. Radiology, 289(1), 83–89. https://doi.org/10.1148/radiol.2018172874
Gadde, K. M., Allison, D. B., Ryan, D. H., Peterson, C. A., Troupin, B., Schwiers, M. L., & Day, W. W. (2011). Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet (London, England), 377(9774), 1341–1352. https://doi.org/10.1016/S0140-6736(11)60205-5
Garcia-Reyes, K., & Fischman, A. (2020). Anatomical and Technical Considerations for Bariatric Embolization. Techniques in vascular and interventional radiology, 23(1), 100657. https://doi.org/10.1016/j.tvir.2020.100657
Garvey, W. T., Ryan, D. H., Look, M., Gadde, K. M., Allison, D. B., Peterson, C. A., Schwiers, M., Day, W. W., & Bowden, C. H. (2012). Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. The American journal of clinical nutrition, 95(2), 297–308. https://doi.org/10.3945/ajcn.111.024927
Glandt, M., & Raz, I. (2011). Present and future: pharmacologic treatment of obesity. Journal of obesity, 2011, 636181. https://doi.org/10.1155/2011/636181
González-Muniesa, P., Mártinez-González, M. A., Hu, F. B., Després, J. P., Matsuzawa, Y., Loos, R., Moreno, L. A., Bray, G. A., & Martinez, J. A. (2017). Obesity. Nature reviews. Disease primers, 3, 17034. https://doi.org/10.1038/nrdp.2017.34
Gregorczyk, M., & Agnieszka, J. (2015, September 3). Arterial supply of gastric fundus in human – final results. MEDtube Science, 30-34. https://medtube.net/science/arterial-supply-of-gastric-fundus-in-human-final-results/
Gunn, A. J., & Oklu, R. (2014). A preliminary observation of weight loss following left gastric artery embolization in humans. Journal of obesity, 2014, 185349. https://doi.org/10.1155/2014/185349
Gunn, A. J., & Weiss, C. R. (2019). Is There a Role for Bariatric Embolization in the Treatment of the Diabetic Patient?. Journal of vascular and interventional radiology : JVIR, 30(6), 797–800. https://doi.org/10.1016/j.jvir.2019.03.009
Hafezi-Nejad, N., Bailey, C. R., & Weiss, C. R. (2020). Bariatric Embolization: A Narrative Review of Clinical Data From Human Trials. Techniques in vascular and interventional radiology, 23(1), 100658. https://doi.org/10.1016/j.tvir.2020.100658
Hendricks, E. J., Srisurapanont, M., Schmidt, S. L., Haggard, M., Souter, S., Mitchell, C. L., De Marco, D. G., Hendricks, M. J., Istratiy, Y., & Greenway, F. L. (2014). Addiction potential of phentermine prescribed during long-term treatment of obesity. International journal of obesity (2005), 38(2), 292–298. https://doi.org/10.1038/ijo.2013.74
Hvizdos, K. M., & Markham, A. (1999). Orlistat: a review of its use in the management of obesity. Drugs, 58(4), 743–760. https://doi.org/10.2165/00003495-199958040-00015
Jones, L. R., Wilson, C. I., & Wadden, T. A. (2007). Lifestyle modification in the treatment of obesity: an educational challenge and opportunity. Clinical pharmacology and therapeutics, 81(5), 776–779. https://doi.org/10.1038/sj.clpt.6100155
Kim, D. J., Raman, H. S., Salter, A., Ramaswamy, R., Gunn, A. J., Weiss, C. R., & Akinwande, O. (2018). Analysis of weight changes after left gastric artery embolization in a cancer-naive population. Diagnostic and interventional radiology (Ankara, Turkey), 24(2), 94–97. https://doi.org/10.5152/dir.2018.17412
Kim, J. M., Kim, M. D., Han, K., Muqmiroh, L., Kim, S. U., Kim, G. M., Kwon, J., Park, S. I., Won, J. Y., & Lee, D. Y. (2017). Bariatric Arterial Embolization with Non-spherical Polyvinyl Alcohol Particles for Ghrelin Suppression in a Swine Model. Cardiovascular and interventional radiology, 40(5), 744–749. https://doi.org/10.1007/s00270-017-1600-x
Kipshidze, N., Archvadze, A., Bertog, S., Leon, M. B., & Sievert, H. (2015). Endovascular Bariatrics: First in Humans Study of Gastric Artery Embolization for Weight Loss. JACC. Cardiovascular interventions, 8(12), 1641–1644. https://doi.org/10.1016/j.jcin.2015.07.016
Kojima, M., Hosoda, H., Date, Y., Nakazato, M., Matsuo, H., & Kangawa, K. (1999). Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature, 402(6762), 656–660. https://doi.org/10.1038/45230
Kumar, N., & Thompson, C. C. (2011). Endoscopic solutions for weight loss. Current opinion in gastroenterology, 27(5), 407–411. https://doi.org/10.1097/MOG.0b013e328349e240
Maahs, D., de Serna, D. G., Kolotkin, R. L., Ralston, S., Sandate, J., Qualls, C., & Schade, D. S. (2006). Randomized, double-blind, placebo-controlled trial of orlistat for weight loss in adolescents. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 12(1), 18–28. https://doi.org/10.4158/EP.12.1.18
Madoff D. C. (2013). Science to practice: can transarterial embolotherapy be used as a viable alternative to treat obesity?. Radiology, 266(2), 369–371. https://doi.org/10.1148/radiol.12122561
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med, 6(7), e1000097
O'Neil, P. M., Smith, S. R., Weissman, N. J., Fidler, M. C., Sanchez, M., Zhang, J., Raether, B., Anderson, C. M., & Shanahan, W. R. (2012). Randomized placebo-controlled clinical trial of lorcaserin for weight loss in type 2 diabetes mellitus: the BLOOM-DM study. Obesity (Silver Spring, Md.), 20(7), 1426–1436. https://doi.org/10.1038/oby.2012.66
Park, Y. S., Ahn, S. H., Suh, Y. S., & Kim, H. H. (2020). Less Invasive Bariatric/Metabolic Procedures for Weight Reduction and Glucose Control. Journal of obesity & metabolic syndrome, 29(2), 110–113. https://doi.org/10.7570/jomes20019
Paxton, B. E., Kim, C. Y., Alley, C. L., Crow, J. H., Balmadrid, B., Keith, C. G., Kankotia, R. J., Stinnett, S., & Arepally, A. (2013). Bariatric embolization for suppression of the hunger hormone ghrelin in a porcine model. Radiology, 266(2), 471–479. https://doi.org/10.1148/radiol.12120242
Piché, M. È., Auclair, A., Harvey, J., Marceau, S., & Poirier, P. (2015). How to choose and use bariatric surgery in 2015. The Canadian journal of cardiology, 31(2), 153–166. https://doi.org/10.1016/j.cjca.2014.12.014
Pirlet, C., Ruzsa, Z., Costerousse, O., Nemes, B., Merkely, B., Poirier, P., & Bertrand, O. F. (2019). Transradial left gastric artery embolization to treat severe obesity: A pilot study. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 93(3), 365–370. https://doi.org/10.1002/ccd.27846
Pi-Sunyer, X., Astrup, A., Fujioka, K., Greenway, F., Halpern, A., Krempf, M., Lau, D. C., le Roux, C. W., Violante Ortiz, R., Jensen, C. B., Wilding, J. P., & SCALE Obesity and Prediabetes NN8022-1839 Study Group (2015). A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. The New England journal of medicine, 373(1), 11–22. https://doi.org/10.1056/NEJMoa1411892
Prochaska, J. M., Flye, M. W., & Johnsrude, I. S. (1973). Left Gastric Artery Embolization for Control of Gastric Bleeding: A Complication. Radioogy Journal, Vol. 107(No. 3), 521-522. https://doi.org/10.1148/107.3.521
Reoch, J., Mottillo, S., Shimony, A., Filion, K. B., Christou, N. V., Joseph, L., Poirier, P., & Eisenberg, M. J. (2011). Safety of laparoscopic vs open bariatric surgery: a systematic review and meta-analysis. Archives of surgery (Chicago, Ill. : 1960), 146(11), 1314–1322. https://doi.org/10.1001/archsurg.2011.270
Salsamendi, J., Pereira, K., Kang, K., & Fan, J. (2015). Minimally invasive percutaneous endovascular therapies in the management of complications of non-alcoholic fatty liver disease (NAFLD): A case report. Journal of radiology case reports, 9(9), 36–43. https://doi.org/10.3941/jrcr.v9i9.2557
Stefater, M. A., Kohli, R., & Inge, T. H. (2013). Advances in the surgical treatment of morbid obesity. Molecular aspects of medicine, 34(1), 84–94. https://doi.org/10.1016/j.mam.2012.10.006
Syed, M. I., Morar, K., Shaikh, A., Craig, P., Khan, O., Patel, S., & Khabiri, H. (2016). Gastric Artery Embolization Trial for the Lessening of Appetite Nonsurgically (GET LEAN): Six-Month Preliminary Data. Journal of vascular and interventional radiology : JVIR, 27(10), 1502–1508. https://doi.org/10.1016/j.jvir.2016.07.010
Takahashi, E. A., Takahashi, N., Reisenauer, C. J., Moynagh, M. R., & Misra, S. (2019). Body composition changes after left gastric artery embolization in overweight and obese individuals. Abdominal radiology (New York), 44(7), 2627–2631. https://doi.org/10.1007/s00261-019-02002-6
Takiguchi, S., Adachi, S., Yamamoto, K., Morii, E., Miyata, H., Nakajima, K., Yamasaki, M., Kangawa, K., Mori, M., & Doki, Y. (2012). Mapping analysis of ghrelin producing cells in the human stomach associated with chronic gastritis and early cancers. Digestive diseases and sciences, 57(5), 1238–1246. https://doi.org/10.1007/s10620-011-1986-2
Torgerson, J. S., Hauptman, J., Boldrin, M. N., & Sjöström, L. (2004). XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes care, 27(1), 155–161. https://doi.org/10.2337/diacare.27.1.155
Vaidya, S., Tozer, K. R., & Chen, J. (2008). An overview of embolic agents. Seminars in interventional radiology, 25(3), 204–215. https://doi.org/10.1055/s-0028-1085930
Vairavamurthy, J., Cheskin, L. J., Kraitchman, D. L., Arepally, A., & Weiss, C. R. (2017). Current and cutting-edge interventions for the treatment of obese patients. European journal of radiology, 93, 134–142. https://doi.org/10.1016/j.ejrad.2017.05.019
Verdam, F. J., Schouten, R., Greve, J. W., Koek, G. H., & Bouvy, N. D. (2012). An update on less invasive and endoscopic techniques mimicking the effect of bariatric surgery. Journal of obesity, 2012, 597871. https://doi.org/10.1155/2012/597871
Weir, M. A., Beyea, M. M., Gomes, T., Juurlink, D. N., Mamdani, M., Blake, P. G., Wald, R., & Garg, A. X. (2011). Orlistat and acute kidney injury: an analysis of 953 patients. Archives of internal medicine, 171(7), 703–704. https://doi.org/10.1001/archinternmed.2011.103
Weiss, C. R., & Kathait, A. S. (2017). Bariatric embolization: a new and effective option for the obese patient?. Expert review of gastroenterology & hepatology, 11(4), 293–302. https://doi.org/10.1080/17474124.2017.1294060
Weiss, C. R., Akinwande, O., Paudel, K., Cheskin, L. J., Holly, B., Hong, K., Fischman, A. M., Patel, R. S., Shin, E. J., Steele, K. E., Moran, T. H., Kaiser, K., Park, A., Shade, D. M., Kraitchman, D. L., & Arepally, A. (2017). Clinical Safety of Bariatric Arterial Embolization: Preliminary Results of the BEAT Obesity Trial. Radiology, 283(2), 598–608. https://doi.org/10.1148/radiol.2016160914
Weiss, C. R., Gunn, A. J., Kim, C. Y., Paxton, B. E., Kraitchman, D. L., & Arepally, A. (2015). Bariatric embolization of the gastric arteries for the treatment of obesity. Journal of vascular and interventional radiology : JVIR, 26(5), 613–624. https://doi.org/10.1016/j.jvir.2015.01.017
Williams, E. P., Mesidor, M., Winters, K., Dubbert, P. M., & Wyatt, S. B. (2015). Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem. Current obesity reports, 4(3), 363–370. https://doi.org/10.1007/s13679-015-0169-4
World Health Organization, W. H. O. (2000). Obesity: preventing and managing the global epidemic (WHO Technical Report Series 894). Report of a WHO Consultation.
World Health Organization, W. H. O. (2016). Obesity and overweight. World Health Organization website. Retrieved March 24, 2020, from http://www.who.int/mediacentre/factsheets/fs311/en/
Wren, A. M., & Bloom, S. R. (2007). Gut hormones and appetite control. Gastroenterology, 132(6), 2116–2130. https://doi.org/10.1053/j.gastro.2007.03.048
Wren, A. M., Seal, L. J., Cohen, M. A., Brynes, A. E., Frost, G. S., Murphy, K. G., Dhillo, W. S., Ghatei, M. A., & Bloom, S. R. (2001). Ghrelin enhances appetite and increases food intake in humans. The Journal of clinical endocrinology and metabolism, 86(12), 5992. https://doi.org/10.1210/jcem.86.12.8111
Yanovski, S. Z., & Yanovski, J. A. (2014). Long-term drug treatment for obesity: a systematic and clinical review. JAMA, 311(1), 74–86. https://doi.org/10.1001/jama.2013.281361
Zaitoun, M., Basha, M., Hassan, F., Elsayed, S. B., Farag, A. A., Amer, M., Aly, S. A., & Zaitoun, N. (2019). Left Gastric Artery Embolization in Obese, Prediabetic Patients: A Pilot Study. Journal of vascular and interventional radiology : JVIR, 30(6), 790–796. https://doi.org/10.1016/j.jvir.2019.02.010
Zhong, B. Y., Abiola, G., & Weiss, C. R. (2018). Bariatric Arterial Embolization for Obesity: A Review of Early Clinical Evidence. Cardiovascular and interventional radiology, 41(11), 1639–1647. https://doi.org/10.1007/s00270-018-1996-y
Zhong, B. Y., Li, P. C., & Ni, C. F. (2019). Research progress of bariatric embolization for treatment of obesity. Chinese medical journal, 132(7), 880–882. https://doi.org/10.1097/CM9.00000000000001552
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Copyright (c) 2021 Mateus Nunes Carvalho; Edvaldo Pereira de Moura Filho; Igor Matheus Oliveira Silva; Jose Fernandes Neto; Carlos Augusto Cavalcante de Vasconcelos; Raissa Pinheiro Nery; Raissa Martins de Oliveira Nunes; Ramodnil de Moura Santos; Luan Kelves Miranda de Souza
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