The Effectiveness of Endoscopic Gastroplasty for Obesity Treatment According to FDA Thresholds: Systematic Review and Meta-Analysis Based on Randomized Controlled Trials

Abstract

Endoscopic bariatric therapies (EBTs) are promising alternatives to conventional surgery for obesity. The aim of this study is to compare efficacy and safety through a systematic review and meta-analysis of the endoscopic gastroplasty techniques versus conservative treatment. We searched MEDLINE, EMBASE, Cochrane CENTRAL, Lilacs/Bireme. Randomized controlled trials (RCTs) enrolling obese patients comparing endoscopic gastroplasty to sham or diet/exercise were considered eligible. Among 6014 records, three RCTs were selected for meta-analysis. The total sample was 459 patients (312 EBTs vs 147 control). Mean total body weight loss in the intervention group (IG) was 4.8% higher than the control group (CG) at 12 months (p = 0.01). The IG responder rate was 44.31% at 12 months. Therefore, the endoscopic gastroplasty is more effective than conservative therapies but do not achieve FDA thresholds.

Efficacy of endoscopic gastrojejunal bypass in obese Yucatan pigs: a comparative animal study

“…Despite the recognized place for bariatric surgery, emerging endoscopic bariatric techniques had been developed in last decade, initially used as bridge to surgery, with possible reversibility. Drawbacks consist of limited long-term weight loss maintain for balloon device (14-16), limited patient acceptability for aspiration devices (15) and mixed results for endoscopic gastroplasty in meta-analysis and when the latter are compared to FDA thresholds (16)(17)(18)(19). The e cacy of RYGB surgery is partially based on food from proximal intestine (including malabsorptive effect and global energy homeostasis alteration) (20).…”

Cirugía bariátrica tras el fracaso de las técnicas endoscópicas. ¿es segura su realización?

“…Hasta la fecha, se han descrito pocos artículos en los que se valore la dificultad de la cirugía bariátrica en pacientes obesos que previamente hayan sido tratados mediante procedimientos endoscópicos y hayan fracasado. Recientemente ha sido publicado una revisión sistemática y metaanálisis sobre la eficacia y seguridad de las técnicas endoscópicas 11 , en la que se incluyen un total de 459 pacientes en tres ensayos clínicos controlados (312 intervenidos bajo técnicas endoscópicas y 147 de grupo control) con IMC>30kg/m 2 . El porcentaje de peso total perdido (%TWL) en el grupo endoscópico fue de 5.87%, mostrando diferencias estadísticamente significativas respecto al grupo control.…”

“…El sistema de sutura Overstitch (Apollo Endosurgery), se acopla a la punta del endoscopio y tras ser introducido 7,8 por vía oral, realiza una reducción que intenta imitar a la gastrectomía vertical mediante la realización desde la luz del estómago de una serie de puntos transmurales colocando las suturas muy próximas unas a otras desde el antro prepilórico hasta la unión gastroesofágica 9 . Uno de los problemas de estos procedimientos es, posiblemente, utilizarlo en todo tipo de pacientes obesos, sobrepasando los límites establecidos actualmente [10][11][12] , lo que hace que un porcentaje de estos pacientes fracasen y, posteriormente, busquen otra alternativa. El objetivo de este trabajo es valorar la seguridad de la cirugía bariátrica en pacientes obesos previamente tratados mediante técnicas endoscópicas, así como describir y analizar las dificultades, complicaciones y resultados obtenidos a corto plazo.…”

Exclusively endoscopic approach to treating gastric perforation caused by an intragastric balloon: case series and literature review

“…Due to their low resistance to the effects of gastric acid, earlier versions of IGBs lasted no more than 3 to 4 months 18 . The most common side effects associated with use of those IGBs were nausea, difficulty in inflating or deflating the balloon, unexpected deflation, and migration, any of which could lead to serious complications 19 20 21 . To address this concern, specialists organized a conference to determine the ideal characteristics of safe and effective IGB practice 19 .…”