Endoscopic therapies for patients with obesity: a systematic review and meta-analysis.

Autor: Weitzner ZN; Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA., Phan J; Department of Gastroenterology, Keck School of Medicine, University of Southern California, Los Angeles, USA., Begashaw MM; Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, USA., Mak SS; Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, USA., Booth MS; RAND Corporation, Santa Monica, USA., Shekelle PG; Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.; Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, USA., Maggard-Gibbons M; Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.; Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, USA., Girgis MD; Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA. mdgirgis@mednet.ucla.edu.; Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, USA. mdgirgis@mednet.ucla.edu.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Nov; Vol. 37 (11), pp. 8166-8177. Date of Electronic Publication: 2023 Sep 20.
DOI: 10.1007/s00464-023-10390-6
Abstrakt: Background: Obesity is a major threat to public health and traditional bariatric surgery continues to have low utilization. Endoscopic treatments for obesity have emerged that offer less risk, but questions remain regarding efficacy, durability, and safety. We compared the efficacy of endoscopic bariatric procedures as compared to other existing treatments.
Methods: A literature search of Embase, Cochrane Central, and Pubmed was conducted from January 1, 2014 to December 7, 2021, including endoscopic bariatric therapies that were FDA or CE approved at the time of search to non-endoscopic treatments. Thirty-seven studies involving 15,639 patients were included. Primary outcomes included % total body weight loss (%TBWL), % excess body weight loss (%EBWL), and adverse events. Secondary outcomes included quality of life data and differences in hemoglobin A1C levels. Strength of clinical trial and observational data were graded according to the Cochrane methods.
Results: Intragastric balloons achieved greater %TBWL with a range of 7.6-14.1% compared to 3.3-6.7% with lifestyle modification at 6 months, and 7.5-14.0% compared to 3.1-7.9%, respectively, at 12 months. When endoscopic sleeve gastroplasty (ESG) was compared to laparoscopic sleeve gastrectomy (LSG), ESG had less %TBWL at 4.7-14.4% compared to 18.8-26.5% after LSG at 6 months, and 4.5-18.6% as compared to 28.4-29.3%, respectively, at 12 months. For the AspireAssist, there was greater %TBWL with aspiration therapy compared to lifestyle modification at 12 months, 12.1-18.3% TBWL versus 3.5-5.9% TBWL, respectively. All endoscopic interventions had higher adverse events rates compared to lifestyle modification.
Conclusion: This review is the first to evaluate various endoscopic bariatric therapies using only RCTs and observational studies for evaluation of weight loss compared with conservative management, lifestyle modification, and bariatric surgery. Endoscopic therapies result in greater weight loss compared to lifestyle modification, but not as much as bariatric surgery. Endoscopic therapies may be beneficial as an alternative to bariatric surgery.
(© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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