An experimental procedure that reduces hunger by burning off part of the stomach lining may produce significant weight loss in people with obesity.
In a small, six-month human trial, the technique, which involves a noninvasive technique called endoscopy, lowered the production of ghrelin, a hormone that stimulates hunger. Participants in the trial lost an average of 7.7 percent of their body weight. One of the 10 female participants lost nearly 26 pounds, decreasing her weight from 209 to 183 pounds (lb).
“Obesity is a chronic, progressive, relapsing, and complex disease,” says the lead study author, Daniel Maselli, MD, an associate director of weight loss at True You Weight Loss, a physician-owned clinic based in Cary, North Carolina. “This procedure is a game-changing innovation for patients with obesity who are seeking safe, effective, and feasible alternatives to invasive surgery or lifelong medications.”
The researchers say the procedure could one day provide an additional option for patients who don’t want or aren’t eligible for bariatric surgery or anti-obesity medications, such as Wegovy and Zepbound.
The study findings, which have not yet been published in a peer-reviewed journal, will be presented at the American Gastroenterological Association’s Digestive Disease Week meeting, held May 18 to 21 in Washington, DC.
Gastric Mucosal Ablation Does Not Require Surgical Incisions
The experimental treatment, called gastric mucosal ablation, does not require surgery, but involves a tiny device to ablate, or burn, the mucosal lining of the upper portion of the stomach, known as the gastric fundus.
While a patient is asleep under general anesthesia, a physician passes an endoscope (a flexible tube with a camera) through the patient’s mouth, down the esophagus, and into the fundus.
First, saline (salt water) fluid is infused into the wall of the stomach to protect underlying tissues. Then the doctor guides a catheter through the endoscope to the desired spot in the stomach. Finally, using a method called argon plasma coagulation, the doctor carefully burns off the mucosa, the layer of the fundus where the cells that make the hunger hormone ghrelin are found.
In this trial, the entire procedure took between one and two hours, but Dr. Maselli estimates the duration could be cut down to 45 to 60 minutes as practitioners gain experience. Patients can receive the treatment in an outpatient setting with no hospitalization required, returning home the same day.
Gastric Mucosal Ablation Can Curb Appetite and Stomach Capacity
When the fundus mucosa is burned away, cells that make ghrelin are replaced by scar tissue.
“This causes the fundus to contract, making it less able to expand as we eat a meal, which causes us to get satiated [full] on a much smaller amount of food,” says Maselli.
Three months post-procedure, participants experienced a nearly 42 percent reduction in the amount of meals they needed to eat to feel full.
Levels of ghrelin are typically higher in patients with obesity and rise when people lose weight for any reason — making it hard to maintain weight loss. In this study, levels of ghrelin in the bloodstream were reduced by 45 percent after the ablation.
An Addition to the Weight Loss Toolbox
While research regarding this procedure is in the very early stages, Dan Azagury, MD, the chief of minimally invasive and bariatric surgery at Stanford University in California, views the results as very promising.
“Obesity is a really difficult disease,” he says. “We’ve been trying to find good therapies to fight obesity for decades, and there are so many things that have failed. One therapy might not be sufficient to tackle the disease, so this approach may contribute to the armamentarium of medications, surgeries, and other strategies we have to tackle weight loss.”
Dr. Azagury, who was not involved in the study, adds that the technique is relatively safe and did not lead to any complications. People may experience a few days of mild gastrointestinal symptoms (bloating, cramping, heartburn, and nausea), which can be managed with oral medications if needed.
The study authors recognize that a risk of stomach ulceration exists early after the procedure, during the healing of the fundus. This risk was addressed by having patients take anti-ulcer medications for 12 weeks after the procedure and by avoiding medications known to cause ulcers.
Trials involving more patients over a longer course of time are needed before this option can become commonly available to the general public, according to Azagury.
“These are exciting times for the management of obesity, and having more therapies like this available to patients is a great sign of hope that we will finally be able to tackle this condition,” he says.
