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Endoscopic full-thickness suturing plus argon plasma mucosal coagulation versus argon plasma mucosal coagulation alone for weight regain after gastric bypass: a systematic review and meta-analysis - 20/11/20

Doi : 10.1016/j.gie.2020.07.013 
Veeravich Jaruvongvanich, MD 1, Kornpong Vantanasiri, MD 2, Passisd Laoveeravat, MD 3, Reem H. Matar, BSc 1, Eric J. Vargas, MD 1, Daniel B. Maselli, MD 1, Maryam Alkhatry, MD 4, Lea Fayad, MD 5, Vivek Kumbhari, MD 5, Ricardo Jose Fittipaldi-Fernandez, MD 6, Marcus Hollenbach, MD 7, Rabindra R. Watson, MD 8, Luiz Gustavo de Quadros, MD 9, Manoel Galvao Neto, MD 9, Patrick Aepli, MD 10, Dominic Staudenmann, MD 11, Vitor Ottoboni Brunaldi, MD 12, Andrew C. Storm, MD 1, John A. Martin, MD 1, Victoria Gomez, MD 13, Barham K. Abu Dayyeh, MD, MPH 1, ⁎
1 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 
2 Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota 
3 Department of Internal Medicine, Texas Tech University, Lubbock, Texas, USA 
4 Division of Gastroenterology, IBHO hospital, Ras Al Khaimah, United Arab Emirates 
5 Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA 
6 Department of Bariatric Endoscopy, Endogastro Rio Clinic, Rio de Janeiro, RJ, Brazil 
7 Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology - University of Leipzig Medical Center, Leipzig, Germany 
8 Interventional Endoscopy Services, California Pacific Medical Center, University of California, San Francisco, San Francisco, California, USA 
9 ABC Medical School, Santo André, Brazil 
10 Gastroenterology and Hepatology Unit, Luzerner Kantonsspital, Lucerne, Switzerland 
11 AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 
12 Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil 
13 Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA 

∗Reprint requests: Barham K. Abu Dayyeh, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Division of Gastroenterology and HepatologyMayo Clinic200 First Street SWRochesterMN55905

Abstract

Background and Aims

Endoscopic transoral outlet reduction (TORe) has been used to manage weight regain after Roux-en-Y gastric bypass. We conducted a meta-analysis to summarize the efficacy and safety of the two most commonly used techniques: full-thickness suturing plus argon plasma mucosal coagulation (ft-TORe) and argon plasma mucosal coagulation alone (APMC-TORe).

Methods

A literature search of publication databases was performed from their inception to February 2020 for relevant studies. The outcomes of interest were percentage total body weight loss, gastrojejunal anastomosis (GJA) diameter, and adverse events (AEs). The pooled effect estimates were analyzed using a random-effects model. Meta-regression was conducted to identify associations between GJA diameter and weight loss.

Results

Nine ft-TORe (n = 737) and 7 APMC-TORe (n = 888) studies were included. APMC-TORe was performed as a series of sessions (mean number of sessions ranging from 1.2 to 3), whereas ft-TORe was mostly performed as a single session. Percentage total body weight loss was 8.0% (95% confidence interval [CI], 6.3%-9.7%), 9.5% (95% CI, 8.1%-11.0%), and 5.8% (95% CI, 4.3%-7.1%) after ft-TORe and 9.0% (95% CI, 4.1%-13.9%), 10.2% (95% CI, 8.4%-12.1%), and 9.5% (95% CI, 5.7%-13.2%) after APMC-TORe at 3, 6, and 12 months, respectively, with no weight-loss difference at 3 and 6 months (P > .05). Only one severe AE was observed after APMC-TORe and none after ft-TORe. Stricture formation was the most common AE (ft-TORe 3.3% and APMC-TORe 4.8%, P = .38). All were successfully treated by endoscopic dilation or conservative treatment. Smaller aperture of the post-TORe GJA and greater change in the GJA diameter correlated with greater weight loss in APMC-TORe and numerical trends in ft-TORe.

Conclusions

This meta-analysis demonstrates that both ft-TORe and APMC-TORe offer significant and comparable weight-loss outcomes with a high and comparable safety profile. However, APMC-TORe typically required multiple endoscopic sessions. Identifying a goal for the final and change in GJA diameter could be useful treatment targets.

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Graphical abstract




Le texte complet de cet article est disponible en PDF.

Abbreviations : AE, APMC, CI, ft, GJA, PIVI, RCT, SD, TBWL, TORe


Plan


 DISCLOSURE: Dr Abu Dayyeh is a consultant for Metamodix, BFKW, DyaMx, Boston Scientific, USGI Medical, and Endo-TAGSS. He received research support from Apollo Endosurgery, USGI, Spatz Medical, Boston Scientific, GI Dynamics, Cairn Diagnostics, Aspire Bariatrics, and Medtronic. He served as a speaker for Johnson and Johnson, Endogastric Solutions, and Olympus. Dr Alkhatry served as speaker and trainer for Apollo Endosurgery and Cook Medical. Dr de Quadros is a consultant for Apollo Endosurgery. Dr Galvao Neto is a consultant for Fractyl Labs, GI Dynamics, GI Windows, Apollo Endosurgery, USGI, Colubris Mx, Ethicon EndoSurgery, Medtronics, and Olympus. He is a member of the Keyron Scientific Advisory Board. Dr Gomez is a consultant for Olympus Corporation of America. Dr Kumbhari is a consultant for Medtronic, Pentax Medical, Boston Scientific, FujiFilm, and Apollo Endosurgery. He receives research support from ERBE USA and Apollo Endosurgery. Dr Storm is a consultant for Apollo Endosurgery, ERBE, GI Dynamics, and Endo-TAGSS, and the recipient of research support from Boston Scientific and Apollo Endosurgery. Dr Watson is a consultant for Apollo Endosurgery, Boston Scientific, and Neptune Medical. He served as a speaker for Apollo Endosurgery. All other authors disclosed no financial relationships.


© 2020  American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 92 - N° 6

P. 1164 - décembre 2020 Retour au numéro
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