Comparative efficacy of bariatric endoscopic procedures in the treatment of morbid obesity: a systematic review and network meta-analysis

Abstract

Background The comparative efficacy of bariatric endoscopic procedures has not been completely elucidated. We aimed to comprehensively evaluate the efficacy of bariatric endoscopic procedures. Methods We searched for randomized controlled trials investigating the efficacy of bariatric endoscopic procedures, including the use of an intragastric balloon, duodenal-jejunal bypass liner (DJBL), aspiration therapy, primary obesity surgery endoluminal (POSE) procedure, and botulinum toxin injection to the stomach. Network meta-analyses were performed to determine the percentage of weight loss (%weight loss) and percentage of excess weight loss (%EWL). Results 22 studies with 2141 patients were included in the meta-analysis. Most endoscopic procedures showed superior efficacy in terms of %weight loss compared with the control (mean difference [MD] [95 % confidence interval (CI)]: aspiration therapy 10.4 % [7.0 % to 13.7 %]; fluid-filled balloon 5.3 % [3.4 % to 7.2 %]; POSE 4.9 % [1.7 % to 8.2 %]; and DJBL 4.5 % [1.4 % to 7.7 %]). In terms of %EWL, aspiration therapy, fluid-filled balloon, POSE, and DJBL were superior to the control (MD [95 %CI]: 27.3 % [15.3 % to 39.3 %]; 22.4 % [15.4 % to 29.4 %]; 15.3 % [2.5 % to 28.0 %]; and 13.0 % [4.9 % to 21.2], respectively). The gas-filled balloon and botulinum toxin injection did not show a significant difference in %weight loss or %EWL compared with the control. For the fluid-filled balloon, the %EWL and %weight loss tended to decrease after balloon removal at 6 months after the procedure. Conclusion All bariatric endoscopic procedures, except for gas-filled balloon and botulinum toxin injection to the stomach, showed superior short-term efficacy in terms of %weight loss or %EWL compared with lifestyle modification.

Short-term Outcomes of Intragastric Balloon Placement for Obesity Treatment

“…3 이 중 가장 먼저 시 작된 방법은 위풍선 삽입술로, 4 현재 미국이나 유럽에서 활발하 게 시행되고 있고 단기간의 체중 감량 효과가 입증되었다. [4][5][6][7] 최근 국내에서도 내시경을 통한 위풍선 삽입술의 시행 횟수 가 점차 증가하고 있으나 8,9 위풍선을 제거한 후에도 감소된 체 중이 유지되는지는 명확하지 않고, 관련된 연구 역시 부족하 다. 10…”

Effects of Bariatric Endoscopy on Non-Alcoholic Fatty Liver Disease: A Comprehensive Systematic Review and Meta-Analysis

“…In recent years, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as less invasive methods targeted to achieve comparable results to bariatric surgery for obesity and its metabolic comorbidities at a more affordable cost and a lower risk of complications (8). Currently, six bariatric and metabolicendoscopy devices have been approved by the US Food and Drug Administration (FDA): Orbera Intragastric Balloon System (IGB; Apollo Endosurgery, Austin, TX, USA), Obalon Balloon System (Obalon Therapeutics, Carlsbad, CA, USA), transpyloric shuttle (TPS; BAROnova, San Carlos, CA, USA), OverStitch Endoscopic Suturing System (Apollo Endosurgery) for endoscopic sleeve gastroplasty (ESG), incisionless operating platform (IOP; USGI Medical, San Clemente, CA, USA) for primary obesity surgery endoluminal (POSE), and AspireAssist (Aspire Bariatrics, King of Prussia, PA, USA) for aspiration therapy (AT).…”

Endoscopic Treatment of Obesity and Nutritional Aspects of Bariatric Endoscopy

“…Efficacy in terms of weight loss achieved is around 10-25%. Previous studies have demonstrated that long-term total body weight reduction by 5-10% is sufficient to achieve a significant decrease in the risk of a cardiovascular event or type 2 DM [14,15].…”