内镜袖状胃成形术治疗超重和肥胖：一项国际多中心研究。
Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study.
机构信息
Healthme gerenciamento de perda de peso, Sao Paulo, Brazil.
Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil; Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Gastrointest Endosc. 2019 Nov;90(5):770-780. doi: 10.1016/j.gie.2019.06.013. Epub 2019 Jun 19.
BACKGROUND AND AIMS
Obesity is a pandemic affecting approximately 700 million adults worldwide, with an additional 2 billion overweight. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric therapy that involves remodeling of the greater curvature in an effort to reduce gastric capacity and delay gastric emptying. A variety of ESG suture patterns has been reported. This study is the first to use a uniform "U" stitch pattern across all centers to simplify technical aspects of the procedure and limit cost. This also uniquely assessed outcomes in all body mass index (BMI) categories and changes in metabolic rate, lean body mass, and adipose tissue composition.
METHODS
This is a multicenter analysis of prospectively collected data from 7 centers including patients with overweight and obesity who underwent ESG. Primary outcomes included absolute weight loss, percent total body weight loss (%TWL), change in BMI, and percent excess weight loss (%EWL) at 6 and 12 months in overweight and obese classes I, II, and III. Secondary outcomes included adipose tissue, lean body mass reduction, and metabolic rate analyzed by bioimpedance. Additionally, immediate or delayed adverse events (AEs) were analyzed. Clinical success was defined as achieving ≥25% EWL at 1 year with ≤5% serious AE (SAE) rate following the American Society for Gastrointestinal Endoscopy (ASGE)/American Society for Metabolic and Bariatric Surgery (ASMBS) threshold.
RESULTS
A total of 193 patients underwent ESG during the study period. All groups had >10% TWL and >25% EWL at 6 months of follow-up. On average, %TWL was 14.25% ± 5.26% and 15.06% ± 5.22% and the %EWL 56.15% ± 22.93% and 59.41% ± 25.69% at 6 months and 1 year of follow-up, respectively. %TWL was 8.91% ± .3%, 13.92% ± 5.76%, 16.22% ± 7.69%, and 19.01% ± .95% and %EWL 56.21% ± 2.0%, 62.03% ± 27.63%, 54.13% ± 23.46%, and 46.78% ± 2.43% for overweight and obesity classes I, II, and III, respectively, at 1 year. Male sex, age <41 years, and higher BMI were predictors of achieving a TWL ≥10% at 1-year follow-up. There was a significant reduction in adipose tissue from baseline. SAEs occurred in 1.03%, including 2 perigastric collections needing surgery.
CONCLUSIONS
ESG appears to be feasible, safe, and effective in the treatment of patients with overweight and obesity according to ASGE/ASMBS thresholds.
背景与目的
肥胖是一种全球性的流行病，影响着全球约 7 亿成年人，另有 20 亿人超重。内镜袖状胃成形术（ESG）是一种微创内镜减重治疗方法，通过重塑胃大弯来减少胃容量并延缓胃排空。已经报道了多种 ESG 缝合模式。本研究首次在所有中心使用统一的“U”形缝合模式，以简化手术的技术方面并降低成本。这也首次评估了所有体重指数（BMI）类别中的结果以及代谢率、瘦体重和脂肪组织组成的变化。
方法
这是一项对 7 个中心前瞻性收集数据的多中心分析，包括接受 ESG 的超重和肥胖患者。主要结局包括超重和肥胖 I、II 和 III 类患者在 6 个月和 12 个月时的绝对体重减轻、总体重减轻百分比（%TWL）、BMI 变化和多余体重减轻百分比（%EWL）。次要结局包括通过生物阻抗分析脂肪组织、瘦体重减少和代谢率。此外，还分析了即时或延迟不良事件（AE）。临床成功定义为在 1 年内达到≥25%的 EWL，且美国胃肠内镜学会（ASGE）/美国代谢和减重外科学会（ASMBS）阈值下的严重 AE（SAE）发生率≤5%。
结果
在研究期间，共有 193 名患者接受了 ESG。所有组在 6 个月的随访中均有超过 10%的 TWL 和超过 25%的 EWL。平均而言，6 个月时的%TWL 为 14.25%±5.26%，15.06%±5.22%，1 年时的%EWL 为 56.15%±22.93%和 59.41%±25.69%。6 个月和 1 年随访时，超重和肥胖 I、II 和 III 类患者的%TWL 分别为 8.91%±0.3%、13.92%±5.76%、16.22%±7.69%和 19.01%±0.95%，%EWL 分别为 56.21%±2.0%、62.03%±27.63%、54.13%±23.46%和 46.78%±2.43%。1 年时，男性、年龄<41 岁和较高的 BMI 是达到 1 年 TWL≥10%的预测因素。基线时脂肪组织显著减少。SAE 发生率为 1.03%，包括 2 例需要手术的胃周积液。
结论
根据 ASGE/ASMBS 标准，ESG 似乎是一种可行、安全且有效的超重和肥胖患者治疗方法。
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