Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Digestive Health Center, University of Colorado Hospital, Aurora, Colorado.
Gastroenterology. 2017 Mar;152(4):716-729. doi: 10.1053/j.gastro.2017.01.035. Epub 2017 Jan 29.
BACKGROUND & AIMS: Multiple endoscopic bariatric therapies (EBTs) currently are being evaluated or are in clinical use in the United States. EBTs are well positioned to fill an important gap in the management of obesity and metabolic disease. The purpose of this expert review is to update gastroenterologists on these therapies and provide practice advice on how to incorporate them into clinical practice.
The evidence reviewed in this work is a distillation of comprehensive search of several English-language databases and a manual review of relevant publications (including systematic reviews and meeting abstracts). Best Practice Advice 1: EBTs should be considered in patients with obesity who have been unsuccessful in losing or maintaining weight loss with lifestyle interventions. Best Practice Advice 2: EBTs can be used in patients with severe obesity as a bridge to traditional bariatric surgery. They also can be used as a bridge to allow unrelated interventions that are unable to be performed because of weight limits (ie, orthopedic surgery, organ transplantation). Best Practice Advice 3: Clinicians should use EBTs as part of a structured weight loss program that includes dietary intervention, exercise therapy, and behavior modification, in both the active weight loss phase and the long-term maintenance phase. Best Practice Advice 4: Clinicians should screen all potential EBT candidates with a comprehensive evaluation for medical conditions, comorbidities, and psychosocial or behavioral patterns that contribute to their condition before enrolling patients in a weight loss program that includes EBTs. Best Practice Advice 5: Clinicians incorporating EBTs into their clinical practice should follow up patients prospectively to capture the impact of the EBT program on weight and weight-related comorbidities, and all related adverse outcomes. Poor responders should be identified and offered a detailed evaluation and alternative therapy. Best Practice Advice 6: Clinicians embarking on incorporating EBTs into their clinical practice should have a comprehensive knowledge of the indications, contraindications, risks, benefits, and outcomes of individual EBTs, as well as a practical knowledge of the risks and benefits of alternative therapies for obesity. Best Practice Advice 7: Institutions should establish specific guidelines that are applied consistently across disciplines for granting privileges in EBTs that reflect the necessary knowledge and technical skill a clinician must achieve before being granted privileges to perform these procedures.
目前，美国正在评估或临床应用多种内镜减重治疗（EBT）。EBT 非常适合填补肥胖和代谢性疾病管理中的重要空白。本专家综述的目的是为胃肠病学家更新这些治疗方法，并提供有关如何将其纳入临床实践的实践建议。
本研究中审查的证据是对几种英语数据库进行全面搜索以及对相关出版物（包括系统评价和会议摘要）进行手动审查的结果。最佳实践建议 1：对于生活方式干预未能成功减轻或维持体重的肥胖患者，应考虑使用 EBT。最佳实践建议 2：EBT 可用于严重肥胖患者，作为传统减重手术的桥梁。它们也可用于作为桥梁，允许因体重限制而无法进行的无关干预（例如，骨科手术，器官移植）。最佳实践建议 3：临床医生应将 EBT 用作结构化减重计划的一部分，该计划包括饮食干预，运动疗法和行为改变，既包括主动减肥阶段，也包括长期维持阶段。最佳实践建议 4：在将患者纳入包括 EBT 的减重计划之前，临床医生应通过全面评估医疗状况，合并症以及导致其病情的心理社会或行为模式，对所有潜在的 EBT 候选者进行筛查。最佳实践建议 5：将 EBT 纳入其临床实践的临床医生应前瞻性地随访患者，以捕捉 EBT 计划对体重和与体重相关的合并症的影响，以及所有相关的不良结果。应识别出反应不佳的患者，并为其提供详细评估和替代治疗。最佳实践建议 6：开始将 EBT 纳入其临床实践的临床医生应全面了解各种 EBT 的适应症，禁忌症，风险，益处和结果，以及肥胖症替代疗法的风险和益处的实际知识。最佳实践建议 7：机构应制定具体的指南，这些指南在各个学科中一致应用，以授予 EBT 特权，反映出临床医生在获得进行这些程序的特权之前必须具备的必要知识和技术技能。
