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The future of weight loss is looking more varied by the second. This week, scientists have reported the preliminary findings of a small trial testing out a novel, non-surgical procedure for obesity—one that works by burning part of the mucus-filled lining of the stomach. The patients in the trial lost about 8% of their baseline weight and experienced a significant drop in their hunger.
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The procedure is known as endoscopic mucosal ablation, which is a technique already used to remove precancerous or other abnormal bits of tissue from the digestive tract. Patients first drink a fluid meant to protect the stomach’s tissues, then doctors will send an endoscope down through the esophagus to the uppermost portion of the stomach, also called the gastric fundus. Once there, the endoscope will ablate (burn) the moist, inner lining of the fundus where mucus is produced and abundant.
The fundus is thought to play an important role in generating our sense of hunger. It’s the main source of ghrelin, a hormone that is released and stimulates our appetite when the stomach is empty of food (as we eat, ghrelin levels then decrease). By burning away some of the lining of the fundus, the hope is that enough ghrelin-producing cells can be destroyed to consistently and safely reduce people’s hunger and promote weight loss.
This week, researchers running the first-in-human trial of this method announced their early results at the academic conference Digestive Disease Week.
Ten patients living with obesity, all women, took part in the trial. On average, they lost 7.7% of their body weight and experienced a more than 40% reduction in fasting ghrelin levels. Participants’ average level of self-reported hunger also dropped by a third, while their stomach’s capacity for food and drink decreased by 42%.
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The findings are based on a very small sample size and have yet to be peer-reviewed, so they should be viewed with extra caution. Compared to other recently developed obesity treatments, particularly the emerging class of incretin-based medications such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro, Zepbound), the weight loss effects of endoscopic mucosal ablation are also modest. For comparison, these drugs have been found to reduce people’s weight by 15% to over 20% in clinical trials.
But the researchers behind the trial argue that this procedure can still have its place in the toolbox of obesity treatment. Outside of bariatric surgery, they note, there are no treatments that work by affecting ghrelin levels. And if endoscopic mucosal ablation can lead to a safe and sustained drop in ghrelin, then it could be used as a one-time, less obtrusive procedure that would either replace or complement other treatments, the researchers argue.
“This relatively brief, outpatient, non-surgical procedure can facilitate weight loss and significantly curb hunger, and it could be an additional option for patients who don’t want or aren’t eligible for anti-obesity medications, such as Wegovy and Ozempic, or bariatric surgery,” study researcher Christopher McGowan, MD, a gastroenterologist and medical director of True You Weight Loss, a North Carolina clinic, in a statement released by Digestive Disease Week.
McGowan and his team will look to expand their research with larger trials that will track people’s weight and hunger over longer periods of time.
“This is just the beginning. The first question was whether we can endoscopically reduce hunger and ghrelin. The answer is: yes, we can,” he said.
