Gastric mucosal ablation: A novel endoscopic approach for obesity and metabolic disease
Dr. Kumbhari and his team are developing novel gastric remodeling aimed at improving obesity and obesity-related metabolic conditions by targeting the gastric mucosa. Unlike bariatric surgery, gastric mucosal ablation does not remove any part of the stomach or change its anatomy. Instead, it uses controlled energy delivered through an endoscope to ablate selected areas of the stomach lining while preserving the deeper layers of the stomach wall.
This work is based on the understanding that obesity and metabolic disease are influenced not only by calorie intake but also by biologic signals from the stomach that affect body weight, blood sugar, lipid metabolism and cardiovascular health. Preclinical studies conducted by the team and collaborators have shown consistent metabolic benefits.
In high-fat-diet-induced obese rat models, gastric mucosal devitalization led to reductions in body weight, visceral and subcutaneous fat, liver fat, food intake, and insulin resistance, along with improvements in cholesterol and free fatty acid profiles. Further studies demonstrated that gastric mucosal ablation influences more than weight alone, as it resulted in lower blood pressure and improvements in cardiovascular lipid deposition in obese rat models.
To better reflect human anatomy, Dr. Kumbhari's team evaluated gastric mucosal ablation in porcine models. These studies showed significant weight loss and reductions in visceral adiposity compared with sham controls. Human translational studies further refined this technique.
Using ex vivo human stomach tissue, the team demonstrated that the visual appearance of treated tissue during the procedure can reliably guide the depth of ablation. This allows effective treatment of the mucosa while avoiding injury to the deeper muscle layers of the stomach, supporting procedural standardization and safety.
Early clinical feasibility work showed that gastric mucosal ablation can be performed safely in humans, with histologic confirmation that the stomach lining can be effectively devitalized while preserving protective deeper layers. Building on this experience, Dr. Kumbhari and international collaborators are developing a formal safety framework for gastric mucosal ablation based on data from more than 300 procedures and multiple prospective studies.
Related publications
Fayad L, Oberbach A, Schweitzer M, Askin F, Voltaggio L, Larman T, Enderle M, Hahn H, Khashab MA, Kalloo AN, Kumbhari V. Gastric mucosal devitalization (GMD): Translation to a novel endoscopic metabolic therapy. Endoscopy International Open. 2019.
Oberbach A, Schlichting N, Kullnick Y, Heinrich M, Lehmann S, Retschlag U, Friedrich M, Fayad L, Dietrich A, Khashab MA, Kalloo AN, Kumbhari V. Gastric mucosal devitalization improves blood pressure, renin and cardiovascular lipid deposition in a rat model of obesity. Endoscopy International Open. 2019.
Kumbhari V, Lehmann S, Schlichting N, Heinrich M, Kullnick Y, Retschlag U, Enderle M, Dietrich A, Khashab MA, Kalloo AN, Oberbach A. Gastric mucosal devitalization is safe and effective in reducing body weight and visceral adiposity in a porcine model. Gastrointestinal Endoscopy. 2018.
Oberbach A, Schlichting N, Heinrich M, Kullnick Y, Retschlag U, Lehmann S, Khashab MA, Kalloo AN, Kumbhari V. Gastric mucosal devitalization reduces adiposity and improves lipid and glucose metabolism in obese rats. Gastrointestinal Endoscopy. 2018.