Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota.
Gastrointest Endosc. 2020 Dec;92(6):1164-1175.e6. doi: 10.1016/j.gie.2020.07.013. Epub 2020 Jul 18.
Endoscopic transoral outlet reduction (TORe) has been used to manage weight regain after Roux-en-Y gastric bypass. We conducted a meta-analysis to summarize the efficacy and safety of the two most commonly used techniques: full-thickness suturing plus argon plasma mucosal coagulation (ft-TORe) and argon plasma mucosal coagulation alone (APMC-TORe).
A literature search of publication databases was performed from their inception to February 2020 for relevant studies. The outcomes of interest were percentage total body weight loss, gastrojejunal anastomosis (GJA) diameter, and adverse events (AEs). The pooled effect estimates were analyzed using a random-effects model. Meta-regression was conducted to identify associations between GJA diameter and weight loss.
Nine ft-TORe (n = 737) and 7 APMC-TORe (n = 888) studies were included. APMC-TORe was performed as a series of sessions (mean number of sessions ranging from 1.2 to 3), whereas ft-TORe was mostly performed as a single session. Percentage total body weight loss was 8.0% (95% confidence interval [CI], 6.3%-9.7%), 9.5% (95% CI, 8.1%-11.0%), and 5.8% (95% CI, 4.3%-7.1%) after ft-TORe and 9.0% (95% CI, 4.1%-13.9%), 10.2% (95% CI, 8.4%-12.1%), and 9.5% (95% CI, 5.7%-13.2%) after APMC-TORe at 3, 6, and 12 months, respectively, with no weight-loss difference at 3 and 6 months (P > .05). Only one severe AE was observed after APMC-TORe and none after ft-TORe. Stricture formation was the most common AE (ft-TORe 3.3% and APMC-TORe 4.8%, P = .38). All were successfully treated by endoscopic dilation or conservative treatment. Smaller aperture of the post-TORe GJA and greater change in the GJA diameter correlated with greater weight loss in APMC-TORe and numerical trends in ft-TORe.
This meta-analysis demonstrates that both ft-TORe and APMC-TORe offer significant and comparable weight-loss outcomes with a high and comparable safety profile. However, APMC-TORe typically required multiple endoscopic sessions. Identifying a goal for the final and change in GJA diameter could be useful treatment targets.
经口内镜下咽腔缩窄术（TORe）已用于治疗 Roux-en-Y 胃旁路术后体重反弹。我们进行了一项荟萃分析，以总结两种最常用技术的疗效和安全性：全层缝合加氩等离子体黏膜凝固（ft-TORe）和单纯氩等离子体黏膜凝固（APMC-TORe）。
从文献数据库建立之初到 2020 年 2 月进行文献检索，以获取相关研究。主要结局指标为总体体重减轻百分比、胃空肠吻合口（GJA）直径和不良事件（AE）。使用随机效应模型分析汇总效应估计值。进行元回归以确定 GJA 直径与减重之间的关联。
纳入 9 项 ft-TORe（n=737）和 7 项 APMC-TORe（n=888）研究。APMC-TORe 作为一系列疗程进行（每次疗程的平均次数从 1.2 到 3 次不等），而 ft-TORe 主要作为单次疗程进行。ft-TORe 治疗 3、6 和 12 个月后分别为 8.0%（95%置信区间[CI]，6.3%-9.7%）、9.5%（95%CI，8.1%-11.0%）和 5.8%（95%CI，4.3%-7.1%），APMC-TORe 治疗后分别为 9.0%（95%CI，4.1%-13.9%）、10.2%（95%CI，8.4%-12.1%）和 9.5%（95%CI，5.7%-13.2%），3 个月和 6 个月时无减重差异（P>.05）。APMC-TORe 后仅观察到 1 例严重 AE，ft-TORe 后未观察到。狭窄形成是最常见的 AE（ft-TORe 为 3.3%，APMC-TORe 为 4.8%，P=.38）。所有病例均通过内镜扩张或保守治疗成功治疗。TORe 后 GJA 孔径较小和 GJA 直径变化较大与 APMC-TORe 减重较大和 ft-TORe 减重呈数值趋势相关。
本荟萃分析表明，ft-TORe 和 APMC-TORe 均可提供显著且相当的减重效果，安全性也相当高。然而，APMC-TORe 通常需要多次内镜治疗。确定最终 GJA 直径和变化的目标可能是有用的治疗靶点。
