Bariatric arterial embolization

Bariatric Arterial Embolization (BAE) is a minimally invasive interventional radiology procedure intended to promote weight loss by embolizing the arteries supplying the gastric fundus, where the hormone ghrelin is produced. BAE is considered a non-surgical alternative to bariatric surgery for the treatment of obesity.

Overview and mechanism of action

BAE involves catheter-based embolization of arteries that feed the gastric fundus. By blocking blood flow to this region, the production of ghrelin (a hormone responsible for stimulating hunger) is reduced. The aim is to decrease appetite and support weight loss without surgically removing any part of the stomach. The fundus of the stomach is responsible for producing around 90% of the body's circulating ghrelin. By reducing blood flow to this area through embolization, the ghrelin output decreases, which suppresses appetite and results in weight loss.^[1]

Weight-Loss Approaches

The most common starting point for weight loss involves adopting healthier eating habits and increasing physical activity. While effective for some, these lifestyle changes often yield only modest results—typically between 5% and 10%—in individuals who are overweight or obese. In cases where obesity presents serious health risks, further medical interventions may be required.^[2]

Pharmacotherapy is another option to support weight loss, though available medications are limited and often associated with side effects. For patients with severe obesity and related comorbidities, bariatric surgery is generally considered a last resort. Surgical procedures such as gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass can produce significant weight loss—up to 36%—but are invasive and carry morbidity risks ranging from 2% to 17%.^[2]

As a less invasive alternative, bariatric embolization is gaining attention. This emerging technique works by reducing blood flow to the portion of the stomach responsible for producing ghrelin, the hunger hormone. It aims to decrease appetite and caloric intake without requiring major surgery, making it a promising middle ground between conservative lifestyle changes and surgical procedures.^[2]

Clinical evidence

Preclinical studies and early human trials have demonstrated that BAE leads to significant weight loss and suppression of ghrelin levels. Trials such as BEAT Obesity and GET LEAN reported average weight loss of 8–14% of total body weight over a 6–12 month period.^[3][4]

A 2023 review also highlighted the procedure's potential, summarizing evidence from multiple clinical and animal studies.^[5]

Candidate criteria

Typical candidates for BAE include:^[6]

• Adults with a BMI ≥ 30 kg/m² (in some trials, ≥ 40 kg/m²)
• Patients unable or unwilling to undergo bariatric surgery
• Individuals with limited success from diet, exercise, or pharmacotherapy

Benefits, limitations and integration with other treatments

Advantages:^[7]

• Minimally invasive
• Shorter recovery time compared to surgery
• Demonstrated safety in early trials

Limitations:^{[citation needed]}

• Long-term effectiveness remains under investigation
• Potential for gastric revascularization and hunger relapse

BAE is often combined with nutritional counseling, lifestyle changes, and medications for optimal long-term outcomes.^[5]

See also

• Bariatric surgery
• Ghrelin
• Interventional radiology
• Obesity