Effects of Celiac and Hepatic Sympathetic Denervation on Glucose Homeostasis: A Scoping Review.

PURPOSE: To map the human and animal evidence on the effects of celiac and hepatic sympathetic denervation on glucose homeostasis and identify gaps to inform future trials.

MATERIALS AND

METHODS

PubMed, Embase, Web of Science, and Scopus were searched from inception to December 2025 for studies reporting glucose outcomes after sympathetic denervation of the celiac plexus, celiac/superior mesenteric ganglia (CSMG), or common hepatic artery perivascular nerves in humans or animals. Vagotomy-only studies were excluded.

CLINICALTRIALS: gov and bioRxiv were also searched. Two reviewers screened records; data were charted per PRISMA-ScR methodology, and one preprint was included and identified as such.

RESULTS

Twenty-nine studies were included: 3 human studies (2 endovascular denervation [EDN] cohorts, n = 41), 25 animal studies (rat, mouse, dog, and pig), and 1 unpublished preprint (mouse). In patients with type 2 diabetes mellitus (T2DM), percutaneous EDN reduced hemoglobin A1c by 0.9-1.9 percentage points at 6-12 months, with no serious adverse events. In animals, sympathetic denervation broadly improved glucose tolerance and reduced hepatic glucose output across species and denervation paradigms. Counterregulatory responses to hypoglycemia showed species-specific divergence: nearly abolished in pigs after complete denervation, attenuated in rats, and preserved in chronically denervated dogs. One preprint found that CSMG ablation recapitulated the glycemic effects of sleeve gastrectomy in obese mice.

CONCLUSION

Celiac and hepatic sympathetic denervation was associated with favorable glycemic effects across human and animal studies, although the human evidence was limited to 2 uncontrolled cohorts. Counterregulatory responses to hypoglycemia varied by species and extent of denervation.