原发性肥胖症内镜手术（POSE）治疗肥胖症：系统评价和荟萃分析。
Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis.
机构信息
Division of Gastroenterology and Hepatology, West Virginia University, 5th Floor Suite 5500, Morgantown, WV, 26506, USA.
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Surg Endosc. 2022 Jan;36(1):252-266. doi: 10.1007/s00464-020-08267-z. Epub 2021 Feb 1.
BACKGROUND
Primary obesity surgery endoluminal (POSE) utilizes an incision-less operating platform system to create full-thickness plications in the gastric fundus and body (original POSE). Many studies have demonstrated the safety and efficacy of original POSE for the treatment of obesity.
OBJECTIVE
We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to evaluate the outcomes of original POSE per the ASGE task force thresholds.
METHODS
Bibliographic databases were systematically searched for studies assessing the outcomes of POSE for the treatment of obesity. All randomized controlled trials (RCTs) and observational studies that assessed outcomes of POSE were included. Studies were included if they reported percent total weight loss (%TWL) or percent excess weight loss (%EWL) and the incidence of serious adverse events (SAE).
RESULTS
A total of seven studies with 613 patients were included. Two included studies were RCTs, while the remaining were observational studies. Pooled mean %EWL at 3-6 months and 12-15 months were 42.62 (95% CI 37.56-47.68) and 48.86 (95% CI 42.31-55.41), respectively. Pooled mean %TWL at 3-6 months and 12-15 months was 13.45 (95% CI 8.93-17.97) and 12.68 (95% CI 8.13-17.23), respectively. Subgroup analysis of two RCTs showed that weight loss at 1 year was significantly higher in POSE patients (%EWL difference in means 19.45 (95% CI 4.65-34.24, p value = 0.01). The overall incidence of serious adverse events was only 2.84% and included GI bleeding, extra-gastric bleeding, hepatic abscess, severe pain, severe nausea, and severe vomiting. The mean number of total anchors placed in the fundus and body was 13.18 (95% CI 11.77-14.58), and the mean procedure time was 44.55 min (95% CI 36.44-52.65).
CONCLUSION
POSE, a minimally invasive endoscopic bariatric therapy, is a safe and effective modality for the treatment of obesity. The outcomes of POSE meet and surpass the ASGE joint task force thresholds. Future studies should evaluate newer versions of this procedure that emphasize gastric body plication sparing the fundus.
背景
原发性肥胖症内镜手术（POSE）利用无切口操作平台系统在胃底和胃体创建全层皱缩（原始 POSE）。许多研究已经证明了原始 POSE 治疗肥胖症的安全性和有效性。
目的
我们旨在对现有文献进行系统回顾和荟萃分析，试图根据 ASGE 工作组的标准来评估原始 POSE 的治疗效果。
方法
系统检索评估 POSE 治疗肥胖症的结果的文献。纳入所有随机对照试验（RCT）和评估 POSE 治疗效果的观察性研究。如果研究报告了总体重减轻百分比（%TWL）或多余体重减轻百分比（%EWL）和严重不良事件（SAE）的发生率，则纳入研究。
结果
共纳入 7 项研究，涉及 613 名患者。其中 2 项研究为 RCT，其余为观察性研究。3-6 个月和 12-15 个月时的平均%EWL 分别为 42.62（95% CI 37.56-47.68）和 48.86（95% CI 42.31-55.41）。3-6 个月和 12-15 个月时的平均%TWL 分别为 13.45（95% CI 8.93-17.97）和 12.68（95% CI 8.13-17.23）。两项 RCT 的亚组分析表明，POSE 组患者的体重减轻在 1 年内显著更高（%EWL 差异平均值为 19.45（95% CI 4.65-34.24，p 值=0.01）。严重不良事件的总体发生率仅为 2.84%，包括胃肠道出血、胃外出血、肝脓肿、严重疼痛、严重恶心和严重呕吐。胃底和胃体共放置的总锚点数平均为 13.18（95% CI 11.77-14.58），平均手术时间为 44.55 分钟（95% CI 36.44-52.65）。
结论
POSE 作为一种微创内镜减肥治疗方法，是治疗肥胖症的一种安全有效的方法。POSE 的治疗效果符合并超过了 ASGE 联合工作组的标准。未来的研究应该评估强调胃体皱缩而不影响胃底的该手术的新版本。
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