Bariatric Arterial Embolization: how to build a clinical program?

Monday, March 6, 2023

5:30 PM – 5:35 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Adham Khalil, MD

Postdoctoral Research Fellow
Johns Hopkins University, Department of Radiology

Disclosure information not submitted.

Author/Co-author(s)

CW

Clifford R. Weiss, MD

Professor
Department of Radiology, Radiological Science and Biomedical Engineering, Johns Hopkins University School of Medicine

Disclosure(s):

Clifford R. Weiss, MD: Boston Scientific: Consultant (Ongoing), Intellectual Property Rights (Ongoing), Research Grant Recipient (Ongoing); Guerbet: Research Grant Recipient (Ongoing); Medtronic: Consultant (Ongoing), Research Grant Recipient (Ongoing); Siemens Healthineers: Consultant (Ongoing), Research Grant Recipient (Ongoing)

Learning Objectives: The goal of this exhibit is to educate the reader on our experience with building a clinical, insurance-supported bariatric arterial embolization (BAE) program that integrates BAE as a part of the standard care path for treating obesity.

Background: Obesity is a major public health issue that contributes to significant disability, cardiovascular risk, mortality, and healthcare costs. Over the last 50 years, there has been a dramatic increase in the prevalence of obesity in the United States. Obesity is associated with an increased risk of all-cause mortality and a significant reduction in life expectancy. For these reasons, obesity has been labeled a major healthcare epidemic in the United States. Thus, there is an urgent need to develop new therapies for obesity.

BAE is an emerging, minimally-invasive therapy for patients with obesity. This image-guided transcatheter procedure involves occlusion of the arteries supplying the gastric fundus, which contains the majority of ghrelin-producing cells. BAE has an excellent safety profile with more than 100 patients with obesity having undergone the procedure worldwide, without any significant adverse sequelae. These early findings suggest that BAE may represent an additional tool in the treatment of patients with obesity that could be used alone or in conjunction with a dedicated lifestyle management program.

Clinical Findings/Procedure Details: Between July 2021 and April 2022, our IR team received 25 consultations for BAE. Of the 25 referrals, 18 patients showed up to their appointments at our clinic, with 7 directly excluded by IR due to technical or medical contraindications and 11 patients considered for interdisciplinary review. In 2 patients, the decision was to give more time with conservative weight management before being re-considered for BAE in the future. One patient declined to pay the out-of-pocket portion after insurance approval. Ultimately, 8 patients were cleared to proceed with BAE. Of whom, 4 patients had already undergone BAE, completed their follow-up with IR, and are currently cared for by their obesity physicians. While the other 4 patients are waiting for CTA assessment and/or appointment for the procedure. All patients with disordered eating behaviors were consulted with a psychiatrist before the procedure to ensure stable condition.

Conclusion and/or Teaching Points: The exhibit provides a step-by-step guide on how to build a successful clinical BAE program including:
- Program structure
- Patient acquisition and workflow
- Multidisciplinary discussion process
- Peri-procedural care
- BAE technique
- Cost analysis
- Pearls and lessons learnt