Marincola Giuseppe, Gallo Camilla, Hassan Cesare, Raffaelli Marco, Costamagna Guido, Bove Vincenzo, Pontecorvi Valerio, Orlandini Beatrice, Boškoski Ivo
Bariatric and Metabolic Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Endosc Int Open. 2021 Jan;9(1):E87-E95. doi: 10.1055/a-1300-1085. Epub 2021 Jan 1.
Laparoscopic sleeve gastrectomy (LSG) is the current standard for bariatric surgery, but it is affected by several postoperative complications. Endoscopic sleeve gastroplasty (ESG) was created as a less invasive alternative to LSG. However, its efficacy and safety compared with LSG is unclear. Relevant publications were identified in MEDLINE/Cochrane/EMBASE/OVID/ PROSPERO and NIH up to January 2020. Studies were selected that included obese patients with a baseline body mass index (BMI) between 30 and 40 kg/m² with a minimum of 12 months of follow-up and with reported incidence of complications. The mean difference in percentage of excess weight loss (%EWL) at 12 months between LSG and ESG represented the primary endpoint. We also assessed the difference in pooled rate of adverse events. The quality of the studies and heterogeneity among them was analyzed. Sixteen studies were selected for a total of 2188 patients (LSG: 1429; ESG: 759) with a mean BMI 34.34 and 34.72 kg/m² for LSG and ESG, respectively. Mean %EWL was 80.32 % (± 12.20; 95 % CI; = 0.001; I² = 98.88) and 62.20 % (± 4.38; 95 % CI; = 0.005; I² = 65.52) for the LSG and ESG groups, respectively, corresponding to an absolute difference of 18.12 % (± 0.89; 95 % CI, = 0.0001). The difference in terms of mean rate of adverse events was 0.19 % (± 0.37; 95 %CI; χ = 1.602; = 0.2056). Our analysis showed a moderate superiority of LSG versus ESG. No difference in terms of safety was shown between the two groups. ESG is a less-invasive, repeatable and reversable and acceptable option for mild-moderate obese patients.
腹腔镜袖状胃切除术（LSG）是目前减肥手术的标准术式，但它会受到多种术后并发症的影响。内镜下袖状胃成形术（ESG）作为一种侵入性较小的替代手术应运而生。然而，与LSG相比，其疗效和安全性尚不清楚。截至2020年1月，在MEDLINE/Cochrane/EMBASE/OVID/PROSPERO和美国国立医学图书馆中检索到相关出版物。入选的研究包括基线体重指数（BMI）在30至40kg/m²之间的肥胖患者，随访时间至少12个月，并报告了并发症发生率。LSG和ESG在12个月时超重体重减轻百分比（%EWL）的平均差异为主要终点。我们还评估了不良事件合并发生率的差异。分析了研究的质量及其异质性。共选择了16项研究，涉及2188例患者（LSG组：1429例；ESG组：759例），LSG组和ESG组的平均BMI分别为34.34和34.72kg/m²。LSG组和ESG组的平均%EWL分别为80.32%（±12.20；95%CI；P = 0.001；I² = 98.88）和62.20%（±4.38；95%CI；P = 0.005；I² = 65.52），绝对差异为18.12%（±0.89；95%CI，P = 0.0001）。不良事件平均发生率的差异为0.19%（±0.37；95%CI；χ² = 1.602；P = 0.2056）。我们的分析显示LSG相对于ESG具有中等优势。两组在安全性方面未显示出差异。ESG对于轻中度肥胖患者是一种侵入性较小、可重复、可逆且可接受的选择。
