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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‡   *
1   Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
,
Jai Hoon Yoon‡   *
2   Division of Gastroenterology, Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
,
Hyuk Soon Choi
3   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
,
Seung-Joo Nam
4   Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
,
Kyoung Oh Kim
5   Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
,
Do Hoon Kim
6   Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
,
Jung-Wook Kim
7   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
,
Won Sohn
8   Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
,
Yil Sik Hyun
9   Division of Gastroenterology, Department of Internal Medicine, Seoul Chuk Hospital, Seoul, Korea
,
Chan Hyuk Park   **
10   Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
,
Hang Lak Lee   **
2   Division 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
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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.

* These authors contributed equally to this work.


** Chan Hyuk Park and Hang Lak Lee are both senior authors for this work.


Supplementary material



Publication History

Received: 14 November 2019

Accepted: 10 March 2020

Article published online:
23 April 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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Refers to:

Author commentary on Sung Hoon Jung et al.Endoscopy 2020; 52(11): v41-v41
DOI: 10.1055/a-1153-5311

 

  • References

  • 1 Grandone A, Di Sessa A, Umano GR. et al. New treatment modalities for obesity. Best Pract Res Clin Endocrinol Metab 2018; 32: 535-549
    CrossrefPubMedGoogle Scholar
  • 2 Godziuk K, Prado CM, Woodhouse LJ. et al. The impact of sarcopenic obesity on knee and hip osteoarthritis: a scoping review. BMC Musculoskelet Disord 2018; 19: 271
    CrossrefPubMedGoogle Scholar
  • 3 Snow V, Barry P, Fitterman N. et al. Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2005; 142: 525-531
    CrossrefPubMedGoogle Scholar
  • 4 Park CH, Nam SJ, Choi HS. et al. Comparative efficacy of bariatric surgery in the treatment of morbid obesity and diabetes mellitus: a systematic review and network meta-analysis. Obes Surg 2019; 29: 2180-2190
    CrossrefPubMedGoogle Scholar
  • 5 Abu Dayyeh BK. ASGE Bariatric Endoscopy Task Force, ASGE Technology Committee. et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc 2015; 82: 425-438 e425
    CrossrefPubMedGoogle Scholar
  • 6 Bazerbachi F, Haffar S, Sawas T. et al. Fluid-filled versus gas-filled intragastric balloons as obesity interventions: a network meta-analysis of randomized trials. Obes Surg 2018; 28: 2617-2625
    CrossrefPubMedGoogle Scholar
  • 7 Thompson CC, Abu Dayyeh BK, Kushner R. et al. Percutaneous gastrostomy device for the treatment of Class II and Class III obesity: results of a randomized controlled trial. Am J Gastroenterol 2017; 112: 447-457
    CrossrefPubMedGoogle Scholar
  • 8 Sullivan S, Swain JM, Woodman G. et al. Randomized sham-controlled trial evaluating efficacy and safety of endoscopic gastric plication for primary obesity: the ESSENTIAL trial. Obesity (Silver Spring) 2017; 25: 294-301
    CrossrefPubMedGoogle Scholar
  • 9 van Rijn S, Roebroek YGM, de Jonge C. et al. Effect of the EndoBarrier device: a 4-year follow-up of a multicenter randomized clinical trial. Obes Surg 2019; 29: 1117-1121
    CrossrefPubMedGoogle Scholar
  • 10 Ponce J, Woodman G, Swain J. et al. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surg Obes Relat Dis 2015; 11: 874-881
    CrossrefPubMedGoogle Scholar
  • 11 Chang SH, Stoll CR, Song J. et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg 2014; 149: 275-287
    CrossrefPubMedGoogle Scholar
  • 12 Courcoulas A, Abu Dayyeh BK, Eaton L. et al. Intragastric balloon as an adjunct to lifestyle intervention: a randomized controlled trial. Int J Obes (Lond) 2017; 41: 427-433
    CrossrefPubMedGoogle Scholar
  • 13 Hoaglin DC, Hawkins N, Jansen JP. et al. Conducting indirect-treatment-comparison and network-meta-analysis studies: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 2. Value Health 2011; 14: 429-437
    CrossrefPubMedGoogle Scholar
  • 14 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264-269
    Google Scholar
  • 15 Jansen JP, Fleurence R, Devine B. et al. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health 2011; 14: 417-428
    CrossrefPubMedGoogle Scholar
  • 16 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
    Google Scholar
  • 17 Higgins J, Green S. Cochrane handbook for systematic reviews of interventions, Version 5.1.0, Chapter 10.4.3.1 Recommendations on testing for funnel plot asymmetry. Available at: Accessed: 31 August 31 2018 https://handbook-5-1.cochrane.org/
    Google Scholar
  • 18 Rucker G. Network meta-analysis, electrical networks and graph theory. Res Synth Methods 2012; 3: 312-324
    CrossrefPubMedGoogle Scholar
  • 19 Rucker G, Schwarzer G. Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Med Res Methodol 2015; 15: 58
    CrossrefPubMedGoogle Scholar
  • 20 Neupane B, Richer D, Bonner AJ. et al. Network meta-analysis using R: a review of currently available automated packages. PLoS One 2014; 9: e115065
    CrossrefPubMedGoogle Scholar
  • 21 Mathus-Vliegen EM, Tytgat GN, Veldhuyzen-Offermans EA. Intragastric balloon in the treatment of super-morbid obesity. Double-blind, sham-controlled, crossover evaluation of 500-milliliter balloon. Gastroenterology 1990; 99: 362-369
    CrossrefPubMedGoogle Scholar
  • 22 Mathus-Vliegen LM, Tytgat GN. Twenty-four-hour pH measurements in morbid obesity: effects of massive overweight, weight loss and gastric distension. Eur J Gastroenterol Hepatol 1996; 8: 635-640
    PubMedGoogle Scholar
  • 23 Mathus-Vliegen EM, Tygat GN. Gastro-oesophageal reflux in obese subjects: influence of overweight, weight loss and chronic gastric balloon distension. Scand J Gastroenterol 2002; 37: 1246-1252
    CrossrefPubMedGoogle Scholar
  • 24 Genco A, Cipriano M, Bacci V. et al. BioEnterics Intragastric Balloon (BIB): a short-term, double-blind, randomised, controlled, crossover study on weight reduction in morbidly obese patients. Int J Obes (Lond) 2006; 30: 129-133
    CrossrefPubMedGoogle Scholar
  • 25 Fuller NR, Pearson S, Lau NS. et al. An intragastric balloon in the treatment of obese individuals with metabolic syndrome: a randomized controlled study. Obesity (Silver Spring) 2013; 21: 1561-1570
    CrossrefPubMedGoogle Scholar
  • 26 Ponce J, Quebbemann BB, Patterson EJ. Prospective, randomized, multicenter study evaluating safety and efficacy of intragastric dual-balloon in obesity. Surg Obes Relat Dis 2013; 9: 290-295
    CrossrefPubMedGoogle Scholar
  • 27 Mohammed MA, Anwar R, Mansour AH. et al. Effects of intragastric balloon versus conservative therapy on appetite regulatory hormones in obese subjects. Trends Med Res 2014; 9: 58-80
    CrossrefPubMedGoogle Scholar
  • 28 Gomez V, Woodman G, Abu Dayyeh BK. Delayed gastric emptying as a proposed mechanism of action during intragastric balloon therapy: results of a prospective study. Obesity (Silver Spring) 2016; 24: 1849-1853
    CrossrefPubMedGoogle Scholar
  • 29 Sullivan S, Swain J, Woodman G. et al. Randomized sham-controlled trial of the 6-month swallowable gas-filled intragastric balloon system for weight loss. Surg Obes Relat Dis 2018; 14: 1876-1889
    CrossrefPubMedGoogle Scholar
  • 30 Tarnoff M, Rodriguez L, Escalona A. et al. Open label, prospective, randomized controlled trial of an endoscopic duodenal-jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery. Surg Endosc 2009; 23: 650-656
    CrossrefPubMedGoogle Scholar
  • 31 Gersin KS, Rothstein RI, Rosenthal RJ. et al. Open-label, sham-controlled trial of an endoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc 2010; 71: 976-982
    CrossrefPubMedGoogle Scholar
  • 32 Schouten R, Rijs CS, Bouvy ND. et al. A multicenter, randomized efficacy study of the EndoBarrier Gastrointestinal Liner for presurgical weight loss prior to bariatric surgery. Ann Surg 2010; 251: 236-243
    CrossrefPubMedGoogle Scholar
  • 33 Koehestanie P, de Jonge C, Berends FJ. et al. The effect of the endoscopic duodenal-jejunal bypass liner on obesity and type 2 diabetes mellitus, a multicenter randomized controlled trial. Ann Surg 2014; 260: 984-992
    CrossrefPubMedGoogle Scholar
  • 34 Miller K, Turro R, Greve JW. et al. MILEPOST multicenter randomized controlled trial: 12-month weight loss and satiety outcomes after pose (SM) vs. medical therapy. Obes Surg 2017; 27: 310-322
    CrossrefPubMedGoogle Scholar
  • 35 Sullivan S, Stein R, Jonnalagadda S. et al. Aspiration therapy leads to weight loss in obese subjects: a pilot study. Gastroenterology 2013; 145: 1245-1252
    CrossrefPubMedGoogle Scholar
  • 36 Gui D, Mingrone G, Valenza V. et al. Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study. Aliment Pharmacol Ther 2006; 23: 675-680
    CrossrefPubMedGoogle Scholar
  • 37 Mittermair R, Keller C, Geibel J. Intragastric injection of botulinum toxin A for the treatment of obesity. Obes Surg 2007; 17: 732-736
    CrossrefPubMedGoogle Scholar
  • 38 de Moura EGH, Ribeiro IB, Frazao MSV. et al. EUS-guided intragastric injection of botulinum toxin A in the preoperative treatment of super-obese patients: a randomized clinical trial. Obes Surg 2019; 29: 32-39
    CrossrefPubMedGoogle Scholar
  • 39 Lerner H, Whang J, Nipper R. Benefit-risk paradigm for clinical trial design of obesity devices: FDA proposal. Surg Endosc 2013; 27: 702-707
    CrossrefPubMedGoogle Scholar
  • 40 ASGE ASMBS Task Force on Endoscopic Bariatric Therapy. Ginsberg GG, Chand B. et al. A pathway to endoscopic bariatric therapies. Gastrointest Endosc 2011; 74: 943-953
    CrossrefPubMedGoogle Scholar
  • 41 Yanovski SZ, Yanovski JA. Obesity. N Engl J Med 2002; 346: 591-602
    CrossrefPubMedGoogle Scholar
  • 42 Knowler WC, Barrett-Connor E, Fowler SE. et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403
    CrossrefPubMedGoogle Scholar
  • 43 De Castro ML, Morales MJ, Del Campo V. et al. Efficacy, safety, and tolerance of two types of intragastric balloons placed in obese subjects: a double-blind comparative study. Obes Surg 2010; 20: 1642-1646
    CrossrefPubMedGoogle Scholar
  • 44 Ikramuddin S, Korner J, Lee WJ. et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA 2013; 309: 2240-2249
    CrossrefPubMedGoogle Scholar
  • 45 Ponce J, Nguyen NT, Hutter M. et al. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011-2014. Surg Obes Relat Dis 2015; 11: 1199-1200
    CrossrefPubMedGoogle Scholar
  • 46 Sullivan S, Edmundowicz SA, Thompson CC. Endoscopic bariatric and metabolic therapies: new and emerging technologies. Gastroenterology 2017; 152: 1791-1801
    CrossrefPubMedGoogle Scholar
  • 47 Hollenbach M, Prettin C, Gundling F. et al. Design of the Weight-loss Endoscopy Trial (WET): a multi-center, randomized, controlled trial comparing weight loss in endoscopically implanted duodenal-jejunal bypass liners vs. intragastric balloons vs. a sham procedure. BMC Gastroenterol 2018; 18: 118
    CrossrefPubMedGoogle Scholar
  • 48 Glaysher MA, Mohanaruban A, Prechtl CG. et al. A randomised controlled trial of a duodenal-jejunal bypass sleeve device (EndoBarrier) compared with standard medical therapy for the management of obese subjects with type 2 diabetes mellitus. BMJ Open 2017; 7: e018598
    PubMedGoogle Scholar
  • 49 Betzel B, Drenth JPH, Siersema PD. Adverse events of the duodenal-jejunal bypass liner: a systematic review. Obes Surg 2018; 28: 3669-3677
    CrossrefPubMedGoogle Scholar
  • 50 Zechmeister-Koss I, Huic M, Fischer S. et al. The duodenal-jejunal bypass liner for the treatment of type 2 diabetes mellitus and/or obesity: a systematic review. Obes Surg 2014; 24: 310-323
    CrossrefPubMedGoogle Scholar