The Battle of Endoscopic Bariatric Therapies for Obesity: Endoscopic Sleeve Gastroplasty Versus Endoscopically Inserted Intragastric Balloon-A Pairwise Meta-Analysis of Comparative Studies and a Call for Randomized Controlled Trials.

Abdul-Rahman F Diab, Joseph A Sujka, Kathleen Mattingly, Mehak Sachdeva, Kenneth Hackbarth, Salvatore Docimo, Christopher G DuCoin
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Abstract

Background: Endoscopic sleeve gastroplasty (ESG) represents the latest primary endoscopic intervention for managing obesity. Both ESG and intragastric balloons (IGBs) have demonstrated effectiveness and safety for weight loss. However, there is a paucity of high-quality evidence supporting the superiority of one over the other, and no pairwise meta-analysis of comparative studies has been published to date. Our aim was to conduct a pairwise meta-analysis of comparative studies directly comparing ESG and IGB.

Methods: We systematically conducted a literature search on PubMed and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search used specific search terms. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) Tool was used to evaluate the quality of the included studies. Data were analyzed using Review Manager (RevMan) 5.4.1 software with a random-effects model. The statistical method used was the Mantel-Haenszel method. For dichotomous data, the effect size was represented using odds ratio (OR), while mean difference (MD) was utilized as the effect size for continuous data.

Results: After screening 967 records, a total of 9 studies met the inclusion criteria for this meta-analysis (5302 patients). The quality assessment categorized 5 studies as having a moderate risk of bias, while 3 studies were classified as having a low risk of bias. Sufficient information was not available for one study to ascertain its overall quality. A statistically significant increase in total weight loss percentage (TWL%) at 1 and 6 months was observed with ESG compared with IGB. In addition, a statistically insignificant decrease in the incidence of adverse events and readmissions was observed with ESG. Furthermore, a statistically significant decrease in the incidence of reintervention was observed with ESG.

Conclusions: While this study suggests a higher TWL% associated with ESG compared with IGB, drawing definitive conclusions is challenging due to limitations identified during a comprehensive quality assessment of the available literature. We advocate for randomized controlled trials (RCTs) directly comparing the newer IGB (with a 12-mo placement duration) with ESG. However, this study consistently reveals higher rates of early reintervention (re-endoscopy) within the IGB group, primarily necessitated by the removal or adjustment of the IGB due to intolerance. Given the additional intervention required at 6 or 12 months to remove the temporarily placed IGB, this trend may imply that IGB is less economically viable than ESG. Cost-effectiveness analyses comparing ESG and IGB are warranted to provide valuable scientific insights.

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内镜减肥疗法与肥胖症之争:内镜袖带胃成形术与内镜插入胃内球囊--一项对比研究的成对分析及对随机对照试验的呼吁》(Endoscopic Sleeve Gastroplasty Versus Endoscopically Inserted Intragastric Balloon- A Pairwise Meta-Analysis of Comparative Studies and a Call for Randomized Controlled Trials)。
背景:内镜袖带胃成形术(ESG)是控制肥胖症的最新初级内镜干预方法。ESG和胃内气球(IGBs)都已证明对减肥有效且安全。然而,支持两者优越性的高质量证据却很少,而且迄今为止还没有发表过对比研究的成对荟萃分析。我们的目的是对直接比较 ESG 和 IGB 的对比研究进行成对荟萃分析:我们按照系统综述和荟萃分析首选报告项目(PRISMA)指南在 PubMed 和 Google Scholar 上进行了系统的文献检索。我们的检索使用了特定的检索词。非随机干预研究中的偏倚风险(ROBINS-I)工具用于评估纳入研究的质量。数据采用随机效应模型,使用Review Manager (RevMan) 5.4.1软件进行分析。使用的统计方法是曼特尔-海恩泽尔法。对于二分法数据,用几率比(OR)表示效应大小;对于连续法数据,用平均差(MD)表示效应大小:结果:在筛选了 967 条记录后,共有 9 项研究符合本次荟萃分析的纳入标准(5302 名患者)。质量评估结果显示,5 项研究存在中度偏倚风险,3 项研究存在低度偏倚风险。有一项研究的信息不足,无法确定其总体质量。与 IGB 相比,ESG 在 1 个月和 6 个月时的总减重百分比 (TWL%) 有明显的统计学增长。此外,ESG 的不良事件发生率和再入院率的下降在统计学上并不明显。此外,ESG 的再介入发生率在统计学上也有显著下降:虽然这项研究表明 ESG 的 TWL% 比 IGB 高,但由于对现有文献进行全面质量评估时发现的局限性,得出明确结论具有挑战性。我们主张进行随机对照试验(RCT),直接比较较新的 IGB(置管时间为 12 个月)和 ESG。然而,本研究一致显示,IGB 组的早期再介入(再内镜检查)率较高,主要是由于不耐受而必须移除或调整 IGB。鉴于需要在 6 个月或 12 个月时进行额外干预以移除临时放置的 IGB,这一趋势可能意味着 IGB 在经济上不如 ESG 可行。有必要对 ESG 和 IGB 进行成本效益分析比较,以提供有价值的科学见解。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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