Cargando…

Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis

BACKGROUND: Endoscopic bariatric and metabolic therapies (EBMTs) are procedures that utilize instruments that require flexible endoscopy or placement of devices for inducing weight loss. We perform a systematic review and meta-analysis to evaluate four modalities – intragastric balloon (IGB), endosc...

Descripción completa

Detalles Bibliográficos
Autores principales: Lee, Shi-Yan, Lai, Haoxing, Chua, Yang Jie, Wang, Min Xian, Lee, Guan-Huei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124896/
https://www.ncbi.nlm.nih.gov/pubmed/35615095
http://dx.doi.org/10.3389/fmed.2022.880749
_version_ 1784711827204079616
author Lee, Shi-Yan
Lai, Haoxing
Chua, Yang Jie
Wang, Min Xian
Lee, Guan-Huei
author_facet Lee, Shi-Yan
Lai, Haoxing
Chua, Yang Jie
Wang, Min Xian
Lee, Guan-Huei
author_sort Lee, Shi-Yan
collection PubMed
description BACKGROUND: Endoscopic bariatric and metabolic therapies (EBMTs) are procedures that utilize instruments that require flexible endoscopy or placement of devices for inducing weight loss. We perform a systematic review and meta-analysis to evaluate four modalities – intragastric balloon (IGB), endoscopic sleeve gastroplasty (ESG), duodeno-jejunal bypass liner (DJBL), and duodenal mucosa resurfacing (DMR), for their efficacy and safety on weight loss, non-alcoholic fatty liver disease, and metabolic syndrome. METHODS: Databases MEDLINE via PubMed, and EMBASE are searched and relevant publications up to January 26, 2022 are assessed. Studies are included if they involved human participants diagnosed with obesity and obesity-related comorbid conditions who are treated with any of the 4 EBMTs. IGB and DJBL were chosen as the interventions for the meta-analysis with weight loss (percentage total body weight loss or body mass index) and glycemic control (fasting plasma glucose or HbA1c) as the two main outcomes analyzed. RESULTS: Six hundred and forty-eight records are reviewed, of which 15 studies are found to be duplicates. Of the 633 records screened, 442 studies are excluded. One hundred and ninety-one articles are assessed for eligibility, for which 171 are excluded. A total of 21 publications are included. Twelve studies are on IGB, two studies on ESG, five studies on DJBL, and two studies on DMR. In these studies with appropriate control, IGB, ESG, and DJBL showed promising benefits on weight loss reduction compared to standard medical therapy (SMT), while DMR appeared to have the least weight reduction benefit. However, the impact on glycemic control featured more prominently in DMR as compared to the rest of the modalities. Different EBMTs have different adverse effect profiles, although device-related adverse events are featured more prominently in DJBL. In the IGB group, there was a significant reduction in 6-month %TBWL [weighted mean difference (WMD) 5.45 (3.88, 7.05)] and FPG WMD −4.89 mg/dL (−7.74, −2.04) compared to the SMT group. There was no significant reduction in BMI between the DJBL and SMT group WMD −2.73 (−5.52, 0.07) kg/m(2). CONCLUSION: EBMTs have demonstrated a significant impact on weight loss and metabolic comorbidities, and reasonable safety profiles in the studies reviewed. Some data is available to demonstrate reduction of hepatic steatosis, but there is no high-quality data supporting benefits on hepatic lobular inflammation or fibrosis.
format Online
Article
Text
id pubmed-9124896
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-91248962022-05-24 Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis Lee, Shi-Yan Lai, Haoxing Chua, Yang Jie Wang, Min Xian Lee, Guan-Huei Front Med (Lausanne) Medicine BACKGROUND: Endoscopic bariatric and metabolic therapies (EBMTs) are procedures that utilize instruments that require flexible endoscopy or placement of devices for inducing weight loss. We perform a systematic review and meta-analysis to evaluate four modalities – intragastric balloon (IGB), endoscopic sleeve gastroplasty (ESG), duodeno-jejunal bypass liner (DJBL), and duodenal mucosa resurfacing (DMR), for their efficacy and safety on weight loss, non-alcoholic fatty liver disease, and metabolic syndrome. METHODS: Databases MEDLINE via PubMed, and EMBASE are searched and relevant publications up to January 26, 2022 are assessed. Studies are included if they involved human participants diagnosed with obesity and obesity-related comorbid conditions who are treated with any of the 4 EBMTs. IGB and DJBL were chosen as the interventions for the meta-analysis with weight loss (percentage total body weight loss or body mass index) and glycemic control (fasting plasma glucose or HbA1c) as the two main outcomes analyzed. RESULTS: Six hundred and forty-eight records are reviewed, of which 15 studies are found to be duplicates. Of the 633 records screened, 442 studies are excluded. One hundred and ninety-one articles are assessed for eligibility, for which 171 are excluded. A total of 21 publications are included. Twelve studies are on IGB, two studies on ESG, five studies on DJBL, and two studies on DMR. In these studies with appropriate control, IGB, ESG, and DJBL showed promising benefits on weight loss reduction compared to standard medical therapy (SMT), while DMR appeared to have the least weight reduction benefit. However, the impact on glycemic control featured more prominently in DMR as compared to the rest of the modalities. Different EBMTs have different adverse effect profiles, although device-related adverse events are featured more prominently in DJBL. In the IGB group, there was a significant reduction in 6-month %TBWL [weighted mean difference (WMD) 5.45 (3.88, 7.05)] and FPG WMD −4.89 mg/dL (−7.74, −2.04) compared to the SMT group. There was no significant reduction in BMI between the DJBL and SMT group WMD −2.73 (−5.52, 0.07) kg/m(2). CONCLUSION: EBMTs have demonstrated a significant impact on weight loss and metabolic comorbidities, and reasonable safety profiles in the studies reviewed. Some data is available to demonstrate reduction of hepatic steatosis, but there is no high-quality data supporting benefits on hepatic lobular inflammation or fibrosis. Frontiers Media S.A. 2022-05-09 /pmc/articles/PMC9124896/ /pubmed/35615095 http://dx.doi.org/10.3389/fmed.2022.880749 Text en Copyright © 2022 Lee, Lai, Chua, Wang and Lee. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Lee, Shi-Yan
Lai, Haoxing
Chua, Yang Jie
Wang, Min Xian
Lee, Guan-Huei
Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis
title Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis
title_full Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis
title_fullStr Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis
title_full_unstemmed Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis
title_short Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis
title_sort endoscopic bariatric and metabolic therapies and their effects on metabolic syndrome and non-alcoholic fatty liver disease - a systematic review and meta-analysis
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124896/
https://www.ncbi.nlm.nih.gov/pubmed/35615095
http://dx.doi.org/10.3389/fmed.2022.880749
work_keys_str_mv AT leeshiyan endoscopicbariatricandmetabolictherapiesandtheireffectsonmetabolicsyndromeandnonalcoholicfattyliverdiseaseasystematicreviewandmetaanalysis
AT laihaoxing endoscopicbariatricandmetabolictherapiesandtheireffectsonmetabolicsyndromeandnonalcoholicfattyliverdiseaseasystematicreviewandmetaanalysis
AT chuayangjie endoscopicbariatricandmetabolictherapiesandtheireffectsonmetabolicsyndromeandnonalcoholicfattyliverdiseaseasystematicreviewandmetaanalysis
AT wangminxian endoscopicbariatricandmetabolictherapiesandtheireffectsonmetabolicsyndromeandnonalcoholicfattyliverdiseaseasystematicreviewandmetaanalysis
AT leeguanhuei endoscopicbariatricandmetabolictherapiesandtheireffectsonmetabolicsyndromeandnonalcoholicfattyliverdiseaseasystematicreviewandmetaanalysis