Endoscopic visceral fat removal as therapy for obesity and metabolic syndrome: A sham-controlled pilot study (with video)

Background: Increased visceral adiposity is a key feature of obesity and metabolic syndrome. Previous studies have generated controversial results regarding visceral fat (VF) removal as a therapy for obesity and metabolic syndrome. Objective: To study the effect of surgical VF removal on metabolic profiles in a mouse model of diet-induced obesity and metabolic syndrome and to evaluate for the first time the feasibility of endoscopic omentectomy using natural orifice transluminal endoscopic surgery (NOTES) technique as treatment for obesity and metabolic syndrome in a feline model. Setting: The Johns Hopkins Hospital. Design: Sham-controlled study in a mouse model of metabolic syndrome and then pilot endoscopic sham-controlled study in cats. Interventions: Partial or total surgical VF removal was performed in a high-fat diet-induced mouse model of obesity and metabolic syndrome, followed by measurements of metabolic profiles, and endoscopic omentectomy was performed in a feline model using the NOTES approach. Main Outcome Measurements: Weight loss and metabolic profiles. Results: In a mouse model of obesity, total but not partial VF removal significantly improved obesity and metabolic syndrome, including insulin resistance and hepatic steatosis (all P <.05 vs sham surgery). The improved metabolic syndrome was associated with significantly decreased inflammatory cytokines. In a feline model, endoscopic omentectomy was feasible and safe and resulted in a net weight loss compared with sham surgery (-387 ± 437 g vs 233 ± 351 g, P =.1, respectively). Limitations: Animal experiments. Conclusions: Endoscopic omentectomy is safe and feasible and has the potential to treat obesity and metabolic syndrome. Near-total VF removal is required to achieve net weight loss and improvement of metabolic syndrome.