Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.
Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, Ohio, USA.
Clin Obes. 2020 Dec;10(6):e12405. doi: 10.1111/cob.12405. Epub 2020 Sep 2.
The efficacy of bariatric surgery in achieving weight loss and preventing long-term comorbidities such as cardiovascular diseases, diabetes mellitus and osteoarthritis is well established. Data regarding safety of bariatric surgery in patients with inflammatory bowel disease (IBD) is scarce. We attempted a systematic review and meta-analysis to evaluate the complications following bariatric surgery in patients with IBD. The primary outcomes evaluated were wound infection, Clavien-Dindo grade > II complications and IBD exacerbation (within 1 year). Secondary outcomes evaluated included overall mortality, stricture, small bowel obstruction, acute kidney injury (AKI) and thromboembolism. Pooled outcomes (event rate) with 95% confidence interval (CI) were calculated using random effects model. A total of 14 studies (all observational) with 2608 patients were included. The rates of primary outcomes were: wound infection (4.1%, 95% CI: 0.9-7.2), Clavien-Dindo grade > II complications (2.0%, 95%: CI 0.6-3.5) and IBD exacerbation (4.3%, 95% CI: 0.7-7.9). The pooled rate for other outcomes was: mortality 0.1%, stricture 6.5%, small bowel obstruction 6.7%, AKI 2.2% and thromboembolism 0.1%. Bariatric surgery is relatively safe in patients with IBD and should be pursued to reduce comorbidities associated with obesity. Future comparative studies are needed to further assess the safety of bariatric surgery in population with and without IBD.
减重手术在减轻体重和预防心血管疾病、糖尿病和骨关节炎等长期合并症方面的疗效已得到充分证实。关于炎症性肠病 (IBD) 患者接受减重手术的安全性数据有限。我们试图进行系统评价和荟萃分析，以评估 IBD 患者接受减重手术后的并发症。评估的主要结局是伤口感染、Clavien-Dindo 分级>2 级的并发症和 IBD 恶化（1 年内）。评估的次要结局包括总死亡率、狭窄、小肠梗阻、急性肾损伤 (AKI) 和血栓栓塞。使用随机效应模型计算汇总结局（事件发生率）和 95%置信区间 (CI)。共纳入 14 项研究（均为观察性研究），共 2608 例患者。主要结局的发生率为：伤口感染（4.1%，95%CI：0.9-7.2）、Clavien-Dindo 分级>2 级的并发症（2.0%，95%CI：0.6-3.5）和 IBD 恶化（4.3%，95%CI：0.7-7.9）。其他结局的汇总发生率为：死亡率 0.1%、狭窄 6.5%、小肠梗阻 6.7%、AKI 2.2%和血栓栓塞 0.1%。减重手术在 IBD 患者中相对安全，应追求手术以降低与肥胖相关的合并症。需要未来的比较研究来进一步评估 IBD 患者和非 IBD 患者接受减重手术的安全性。
