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

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; for the Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity

doi:10.1055/a-1149-1862

Endoscopy, Table of Contents

Endoscopy 2020; 52(11): 940-954
DOI: 10.1055/a-1149-1862

Systematic review

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

Sung Hoon Jung‡^*

¹Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

,

Jai Hoon Yoon‡^*

²Division of Gastroenterology, Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea

,

Hyuk Soon Choi

³Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea

,

Seung-Joo Nam

⁴Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea

,

Kyoung Oh Kim

⁵Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea

,

Do Hoon Kim

⁶Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

,

Jung-Wook Kim

⁷Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea

,

Won Sohn

⁸Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

,

Yil Sik Hyun

⁹Division of Gastroenterology, Department of Internal Medicine, Seoul Chuk Hospital, Seoul, Korea

,

Chan Hyuk Park^**

¹⁰Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea

,

Hang Lak Lee^**

²Division of Gastroenterology, Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea

,

for the Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity

› Author Affiliations

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.

Full Text

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Supplementary Material

Supplementary material