Vagotomy for peptic ulcer, introduced in the 1960ies, is a safe and efficient therapy studied in hundres of thousand of patients world wide. It showed as a side effect in obese patients weight loss and improvement of diabetes. Therefore, Kral introduced the concept of a surgical vagotomy as a treatment option for severe obesity in 1978 (1). Subsequently, truncal vagus injury or vagotomy became part of very effective bariatric surgery approaches (gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass). The concept of vagotomy as a surgical therapy was reintroduced with laparoscopic methods (2). Later, blocking the vagal nerve by stimulation with an active implant, the vBlock therapy, showed promising results in obese patients (3).   

(1) Kral JG.Lancet. Vagotomy for treatment of severe obesity. 1978 Feb 11;1(8059)

(2) Boss TJ, Peters JH, Patti MG, Lustig RH, Kral JG: Laparoscopic truncal vagotomy for weight-loss: a prospective, multi-center safety and efficacy study. Presented to Society of American Gastrointestinal Endoscopic Surgeons 2008.

(3) Apovian CM et al.: Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial Obes Surg. 2017 Jan;27(1):169-176.

Cryovagotomy 

Physicians have long sought an elusive goal of safely interrupting nerve signaling to manage metabolic conditions. The ability of interventional radiologists to access precise targets percutaneously in the body, combined with evolving knowledge regarding the needle ablation of nerves led to the idea of nonsurgically interrupting vagal nerve signaling using available cryoablation technologies (67) (Fig 7a–c). However, no devices using such technologies are currently FDA cleared or approved for weight loss. The mechanisms underpinning appetite and weight control following vagotomy are complex. They involve the interruption of mostly afferent fibers (80%–90%) carrying signals from the gut to the brain, resulting in appetite suppression, weight reduction, and weight loss maintenance (68–70). A single pilot study (67) has evaluated the safety and efficacy of computed tomography– guided percutaneous cryovagotomy in patients who are overweight or have obesity. There were no procedurerelated complications among the 19 subjects who finished the trial (n = 20), supporting the procedure’s feasibility and safety. Additional findings included 95% of the participants reporting decreased appetite during the trial duration, and small but consistent mean reductions in body weight over the same period. A prospective randomized controlled trial (RCT) (n = 30) of percutaneous computed tomography– guided cryovagotomy in patients with type 2 diabetes mellitus is underway (clinicaltrials.gov: NCT04276051).

Interventional Radiology Obesity Therapeutics: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel. J Vasc Interv Radiol 2021; 32:1388.e1–1388.e14