Comparative efficacy of bariatric endoscopic procedures in the treatment of morbid obesity: a systematic review and network meta-analysis.

Abstract

BACKGROUND:

The comparative efficacy of bariatric endoscopic procedures has not been completely elucidated. We aimed to comprehensively evaluate the efficacy of bariatric endoscopic procedures.

METHODS:

We searched for randomized controlled trials investigating the efficacy of bariatric endoscopic procedures, including the use of an intragastric balloon, duodenal-jejunal bypass liner (DJBL), aspiration therapy, primary obesity surgery endoluminal (POSE) procedure, and botulinum toxin injection to the stomach. Network meta-analyses were performed to determine the percentage of weight loss (%weight loss) and percentage of excess weight loss (%EWL).

RESULTS:

22 studies with 2141 patients were included in the meta-analysis. Most endoscopic procedures showed superior efficacy in terms of %weight loss compared with the control (mean difference [MD] [95 % confidence interval (CI)]: aspiration therapy 10.4 % [7.0 % to 13.7 %]; fluid-filled balloon 5.3 % [3.4 % to 7.2 %]; POSE 4.9 % [1.7 % to 8.2 %]; and DJBL 4.5 % [1.4 % to 7.7 %]). In terms of %EWL, aspiration therapy, fluid-filled balloon, POSE, and DJBL were superior to the control (MD [95 %CI]: 27.3 % [15.3 % to 39.3 %]; 22.4 % [15.4 % to 29.4 %]; 15.3 % [2.5 % to 28.0 %]; and 13.0 % [4.9 % to 21.2], respectively). The gas-filled balloon and botulinum toxin injection did not show a significant difference in %weight loss or %EWL compared with the control. For the fluid-filled balloon, the %EWL and %weight loss tended to decrease after balloon removal at 6 months after the procedure.

CONCLUSION:

All bariatric endoscopic procedures, except for gas-filled balloon and botulinum toxin injection to the stomach, showed superior short-term efficacy in terms of %weight loss or %EWL compared with lifestyle modification.

• Authors: Sung Hoon Jung, Jai Hoon Yoon, Hyuk Soon Choi, Seung-Joo Nam, Kyoung Oh Kim, Do Hoon Kim, Jung-Wook Kim, Won Sohn, Yil Sik Hyun, Chan Hyuk Park, Hang Lak Lee, Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity
• Journal: Endoscopy (Endoscopy) Vol. 52 Issue 11 Pg. 940-954 (11 2020) ISSN: 1438-8812 [Electronic] Germany
• PMID: 32325513 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Thieme. All rights reserved.

Topics

• Bariatric Surgery
• Gastric Balloon
• Humans
• Network Meta-Analysis
• Obesity, Morbid (surgery)
• Treatment Outcome