Department of Abdominal Surgery, University Hospital Antwerp, Antwerp, Belgium.
Department of Surgery, Sint-Dimpna Hospital, Geel, Belgium.
Obes Surg. 2019 Sep;29(9):3021-3029. doi: 10.1007/s11695-019-04010-3.
Endoscopic gastric plication or gastroplasty for morbid obesity is gaining worldwide recognition. Data concerning safety and efficacy are rather scarce. Furthermore, clear guidelines are yet to be established. The objective of this meta-analysis is to update the data and investigate the efficacy and safety of the procedure. An online comprehensive search using Cochrane, Google Scholar, PubMed, Web of Science, and Embase on endoscopic gastric plication was completed. The primary outcome was defined as weight loss at 6 months or more after the procedure. Secondary outcomes were defined as the occurrence of adverse events or complications including insufficient weight loss or regain. I statistic was used to define the heterogeneity across studies. Twenty-two cohort studies on 7 different devices met the inclusion criteria, with a total of 2475 patients. The mean baseline BMI was 37.8 ± 4.1 kg/m (median 37.9; range 28.0-60.2). Either a transoral endoluminal stapling or (suction based) (full-thickness) stitching and/or anchor device was used to obtain gastric volume reduction and/or alter gastric outlet. The mean follow-up was 13 months (median 12; range 6-24) for the specified outcomes of each study. Two active, FDA-approved devices were taken into account for meta-analysis: Endoscopic sleeve gastroplasty (ESG) and the primary obesity surgery endolumenal (POSE™). Average pooled %EWL at 6 months (p = 0.02) and 12 months (p = 0.04) in favor of ESG was 57.9 ± 3.8% (50.5-65.5, I = 0.0), 44.4 ± 2.1% (40.2-48.5, I = 0.0), and 68.3 ± 3.8% (60.9-75.7, I = 5.8), 44.9 ± 2.1% (40.9-49.0, I = N/A) for ESG and POSE respectively. Major adverse events without mortality were described in 25 patients (9 studies, p = 0.63). ESG and POSE are both safe and feasible procedures with good short-term weight loss. ESG seems to be superior in terms of weight loss at this point. Few major adverse events are reported and long-term results are awaited.
内镜胃折叠术或胃成形术治疗病态肥胖症正在获得全球认可。关于安全性和疗效的数据相当有限。此外，尚未制定明确的指南。本荟萃分析的目的是更新数据并研究该手术的疗效和安全性。使用 Cochrane、Google Scholar、PubMed、Web of Science 和 Embase 对内镜胃折叠术进行了全面的在线搜索。主要结局定义为术后 6 个月或更长时间的体重减轻。次要结局定义为不良事件或并发症的发生，包括体重减轻不足或反弹。I 统计用于定义研究之间的异质性。符合纳入标准的 7 种不同设备的 22 项队列研究共纳入 2475 名患者。平均基线 BMI 为 37.8 ± 4.1 kg/m²（中位数 37.9；范围 28.0-60.2）。使用经口内镜下吻合器或（基于吸力的）（全层）缝合和/或锚定装置来减少胃容量和/或改变胃出口。每个研究指定结局的平均随访时间为 13 个月（中位数 12；范围 6-24）。考虑到两种经美国食品和药物管理局批准的有源设备进行荟萃分析：内镜袖状胃成形术（ESG）和主要肥胖症内镜治疗（POSE™）。6 个月（p=0.02）和 12 个月（p=0.04）时 ESG 的平均 pooled %EWL 分别为 57.9±3.8%（50.5-65.5，I=0.0）、44.4±2.1%（40.2-48.5，I=0.0）和 68.3±3.8%（60.9-75.7，I=5.8）、44.9±2.1%（40.9-49.0，I=N/A）。分别为 ESG 和 POSE。描述了 25 名患者（9 项研究，p=0.63）发生的重大不良事件但无死亡。ESG 和 POSE 都是安全可行的手术，短期减重效果良好。在这一点上，ESG 似乎更胜一筹。报告的重大不良事件很少，需要等待长期结果。
