A novel experimental procedure designed to reduce hunger by ablating part of the stomach lining may offer significant weight loss benefits for individuals with obesity. This promising technique, known as gastric mucosal ablation, utilizes a noninvasive method called endoscopy to achieve its effects.
In a small-scale, six-month human trial, this innovative procedure demonstrated its potential by lowering the production of ghrelin, a hormone that triggers hunger. Participants in the trial experienced an average weight loss of 7.7 percent of their body weight. Notably, one of the ten female participants lost nearly 26 pounds, reducing her weight from 209 pounds to 183 pounds.
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 says, “Obesity is a chronic, progressive, relapsing, and complex disease. 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 suggest that this procedure could eventually serve as an additional option for patients who either do not wish to undergo bariatric surgery or are not eligible for it, as well as for those who prefer to avoid anti-obesity medications such as Wegovy and Zepbound.
The findings from this study, although not yet published in a peer-reviewed journal, were presented at the American Gastroenterological Association’s Digestive Disease Week meeting, held from May 18 to 21 in Washington, D.C.
Gastric Mucosal Ablation: A Non-Surgical Procedure
The experimental treatment, gastric mucosal ablation, does not require surgical incisions. Instead, it involves using a small device to ablate, or burn, the mucosal lining of the upper part of the stomach, known as the gastric fundus.
During the procedure, the patient is under general anesthesia. A physician inserts an endoscope, a flexible tube equipped with a camera, through the patient’s mouth, down the esophagus, and into the fundus.
The process begins with the infusion of saline (saltwater) fluid into the stomach wall to protect the underlying tissues. The physician then guides a catheter through the endoscope to the targeted area in the stomach. Finally, using a method called argon plasma coagulation, the physician carefully burns away the mucosa, the layer of the fundus that contains cells responsible for producing the hunger hormone ghrelin.
In this trial, the entire procedure lasted between one and two hours. However, Dr. Maselli estimates that with increased practitioner experience, the duration could be reduced to 45 to 60 minutes. Patients can undergo this treatment in an outpatient setting without the need for hospitalization and typically return home the same day.
Gastric Mucosal Ablation: Reducing Appetite and Stomach Capacity
When the fundus mucosa is ablated, the cells that procedure ghrelin are replaced by scar tissue.
Dr. Maselli says, “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.”
Three months after the procedure, participants reported a nearly 42 percent reduction in the amount of food needed to feel full.
Ghrelin levels are typically elevated in patients with obesity and tend to rise when individuals lose weight, making it challenging to maintain weight loss. In this study, ghrelin levels in the bloodstream were reduced by 45 percent following the ablation procedure.
A New Tool for Weight Loss
Despite the early stage of research on this procedure, Dan Azagury, MD, chief of minimally invasive and bariatric surgery at Stanford University in California, finds the results to be very promising.
“Obesity is a really difficult disease,” he remarked. “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, noted that the technique appears relatively safe and did not result in any complications. Participants may experience mild gastrointestinal symptoms, such as bloating, cramping, heartburn, and nausea, for a few days post-procedure, which can be managed with oral medications if necessary.
The study authors acknowledge that there is a risk of stomach ulceration early after the procedure, during the healing of the fundus. To mitigate this risk, patients were prescribed anti-ulcer medications for 12 weeks following the procedure and advised to avoid medications known to cause ulcers.
Further trials involving a larger number of patients and longer follow-up periods are necessary before this treatment option can become widely available to the general public.
“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,” Dr. Azagury concluded.
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