Background and Aims

The early improvement in metabolic profile after sleeve gastrectomy (SG) indicates that the significant benefits of metabolic surgery are gastric in origin. We have previously demonstrated that devitalization of the gastric mucosa (without a reduction in gastric volume) in metabolically disturbed obese rats results in an improvement of obesity and its associated comorbidities. The aims of this study were to assess the technical feasibility, efficacy, and safety of gastric mucosal devitalization (GMD) in a large animal (porcine) model.

Methods

A 3-arm (GMD versus SG versus sham [SH]) prospective randomized controlled trial with an 8-week follow-up period was performed. The primary endpoint was relative weight loss. Secondary endpoints were absolute body weight, abdominal visceral adiposity, abdominal subcutaneous adiposity, organ lipid content, and serum ghrelin level.

Results

GMD resulted in a significant relative weight loss of 36% over SH at 8 weeks (P < .05). There was no significant difference in relative weight loss between GMD and SG at 4 weeks; however, SG resulted in a 29% superior relative weight loss at 8 weeks (P < .05). With regard to visceral adiposity, there was a significant benefit of GMD over SH at 8 weeks. Despite differences in relative weight loss, there was no significant difference in visceral adiposity between SG and GMD at 8 weeks. Significant improvements in GMD over SH were noted with regard to skeletal and heart muscle lipid content. GMD pigs at 8 weeks demonstrated regeneration of the gastric mucosa without ulceration or significant scarring. Despite mucosal regeneration, the abundance of serum ghrelin was significantly lower in the GMD cohort compared with the SG and SH cohorts.

Conclusions

GMD was technically feasible and resulted in relative weight loss and an improvement in visceral adiposity. The benefits noted were out of proportion to what would be expected with weight loss alone.

中文翻译：

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在猪模型中，胃粘膜去活是安全有效的，可减轻体重和内脏脂肪

背景和目标

袖胃切除术（SG）后代谢谱的早期改善表明，代谢手术的显着益处是起源于胃。我们以前已经证明，在代谢紊乱的肥胖大鼠中，胃粘膜的失活（胃体积没有减少）会导致肥胖及其相关合并症的改善。这项研究的目的是评估大型动物（猪）模型中胃黏膜失活（GMD）的技术可行性，功效和安全性。

方法

进行了为期3周的随访（3臂（GMD，SG，sham [SH]）前瞻性随机对照试验。主要终点是相对体重减轻。次要终点是绝对体重，腹部内脏脂肪，腹部皮下脂肪，器官脂质含量和血清生长素释放肽水平。

结果

GMD导致在8周时相对于SH的相对体重显着降低了36％（P  <.05）。4周时，GMD和SG之间的相对体重减轻没有显着差异。然而，SG在8周时的相对体重减轻了29％（P <.05）。关于内脏脂肪，在8周时GMD优于SH。尽管相对减肥有所不同，但在8周时，SG和GMD之间的内脏脂肪没有显着差异。在骨骼和心脏肌肉脂质含量方面，与SH相比，GMD有显着改善。GMD猪在第8周表现出胃黏膜再生，没有溃疡或明显疤痕。尽管有粘膜再生，但与SG和SH队列相比，GMD队列中血清ghrelin的丰度明显较低。

结论

GMD在技术上是可行的，并导致相对的体重减轻和内脏脂肪的改善。所指出的好处与仅减轻体重所期望的好处不成比例。