TY - JOUR
T1 - Endoscopic full-thickness suturing plus argon plasma mucosal coagulation versus argon plasma mucosal coagulation alone for weight regain after gastric bypass
T2 - a systematic review and meta-analysis
AU - Jaruvongvanich, Veeravich
AU - Vantanasiri, Kornpong
AU - Laoveeravat, Passisd
AU - Matar, Reem H.
AU - Vargas, Eric J.
AU - Maselli, Daniel B.
AU - Alkhatry, Maryam
AU - Fayad, Lea
AU - Kumbhari, Vivek
AU - Fittipaldi-Fernandez, Ricardo Jose
AU - Hollenbach, Marcus
AU - Watson, Rabindra R.
AU - Gustavo de Quadros, Luiz
AU - Galvao Neto, Manoel
AU - Aepli, Patrick
AU - Staudenmann, Dominic
AU - Brunaldi, Vitor Ottoboni
AU - Storm, Andrew C.
AU - Martin, John A.
AU - Gomez, Victoria
AU - Abu Dayyeh, Barham K.
N1 - Funding Information:
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.
Funding Information:
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.
Publisher Copyright:
© 2020 American Society for Gastrointestinal Endoscopy
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85093109363&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85093109363&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2020.07.013
DO - 10.1016/j.gie.2020.07.013
M3 - Review article
C2 - 32692991
AN - SCOPUS:85093109363
VL - 92
SP - 1164-1175.e6
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 6
ER -