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Efficacy of Endoscopic Interventions for the Management of Obesity: a Meta-analysis to Compare Endoscopic Sleeve Gastroplasty, AspireAssist, and Primary Obesity Surgery Endolumenal

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Abstract

Background and Aims

Novel endoscopic procedures (endoscopic sleeve gastroplasty (ESG), AspireAssist (AA), and primary obesity surgery endolumenal (POSE)) have been developed for treatment of obesity. We aimed to conduct a systematic review and meta-analysis to evaluate and compare the efficacy of these three endoscopic procedures.

Methods

Main outcomes of interest were percent excess weight loss (%EWL) and percent total body weight loss (%TBWL). Weighted pooled means (WPMs) were calculated and analyzed using random effects model. Mean differences (MDs) were calculated to compare these procedures.

Results

Twelve studies with 1149 patients were included. WPMs for %EWL at 6 and 12 months with ESG were 49.67 (45.67, 53.66) and 52.75 (43.52, 61.98), respectively, while %TBWLs at 6 and 12 months with ESG were 16.01 (15.10, 16.92) and 17.41 (17.08, 17.74), respectively. WPMs for %EWL at 6 and 12 months with POSE were 43.79 (40.17, 47.42) and 44.91 (40.90, 48.92), respectively. WPM for %EWL at 12 months with AA was 50.85 (46.03, 55.68). While comparing ESG and POSE, at 6 months and 12 months, MD for %EWL was 6.17 (1.07, 11.26; P = 0.01) and 7.84 (− 2.05, 17.71; P = 0.06) in favor of ESG. No difference in %EWL was observed while comparing ESG with AA (P = 0.29). Likewise, MD for %EWL to compare AA and POSE was not significant (P = 0.68).

Conclusions

During a follow-up of 6–12 months, both AA and ESG had excellent efficacy in achieving significant and sustained weight loss; however, ESG was found to be superior in terms of weight loss when compared with POSE.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, University of Toledo, Toledo, OH, USA

    Zubair Khan & Wade Lee

  2. Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL, USA

    Muhammad Ali Khan & Mohamed Abdul

  3. Division of Gastroenterology, Weill Cornell College of Medicine, New York, NY, USA

    Kaveh Hajifathalian, Shawn Shah, Monica Saumoy, Louis Aronne & Reem Z. Sharaiha

Authors
  1. Zubair Khan
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  2. Muhammad Ali Khan
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  3. Kaveh Hajifathalian
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  4. Shawn Shah
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  5. Mohamed Abdul
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  7. Louis Aronne
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  8. Wade Lee
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  9. Reem Z. Sharaiha
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Corresponding author

Correspondence to Reem Z. Sharaiha.

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Disclosures and Conflict of Interest

Reem Z. Sharaiha is a consultant of BSC and Apollo Endosurgery. All other authors have no financial disclosures or conflicts of interest relevant to this study.

Ethical Approval

Systematic review and meta-analysis does not require formal consent.

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Informed consent does not apply to this systematic review and meta-analysis.

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Appendix. Quality assessment of studies with NIH Quality assessment tool for before–after studies with no control group

Appendix. Quality assessment of studies with NIH Quality assessment tool for before–after studies with no control group

Criteria

Noren (2016)

Machytka (2017)

Abu Dayyeh (2017)

Lopez (2017)

Sharaiha (2017)

Kumar (2017)

Lopez (2014)

Espinos (2013)

1. Was the study question or objective clearly stated?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

2. Were eligibility/selection criteria for the study population prespecified and clearly described?

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

3. Were the participants in the study representative of those who would be eligible for the test/service/intervention in the general or clinical population of interest?

Yes

N/A

Yes

Yes

Yes

Yes

Yes

Yes

4. Were all eligible participants that met the prespecified entry criteria enrolled?

Yes

N/A

Yes

Yes

Yes

Yes

Yes

Yes

5. Was the sample size sufficiently large to provide confidence in the findings?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

6. Was the test/service/intervention clearly described and delivered consistently across the study population?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

7. Were the outcome measures prespecified, clearly defined, valid, reliable, and assessed consistently across all study participants?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

8. Were the people assessing the outcomes blinded to the participants’ exposures/interventions?

No

No

No

No

No

No

No

No

9. Was the loss to follow-up after baseline 20% or less? Were those lost to follow-up accounted for in the analysis?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

10. Did the statistical methods examine changes in outcome measures from before to after the intervention? Were statistical tests done that provided p values for the pre-to-post changes?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

11. Were outcome measures of interest taken multiple times before the intervention and multiple times after the intervention?

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Result

Good

Fair

Good

Good

Good

Good

Good

Good

NIH, National Institutes of Health; N/A, not applicable

Quality assessment of randomized controlled trial using Cochrane tool for assessing risk of bias

 

Selection bias

Performance bias

Detection bias

Attrition bias

Reporting bias

Other bias

 

Sullivan (2017)

Low risk

High risk

Low risk

Low risk

Low risk

Low risk

 

Miller (2017)

Low risk

High risk

High risk

Low risk

Low risk

Low risk

 

Sullivan (2013)

Low risk

High risk

High risk

Low risk

Low risk

Low risk

 

Thompson (2017)

Low risk

High risk

High risk

Low risk

Low risk

Low risk

 

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Khan, Z., Khan, M.A., Hajifathalian, K. et al. Efficacy of Endoscopic Interventions for the Management of Obesity: a Meta-analysis to Compare Endoscopic Sleeve Gastroplasty, AspireAssist, and Primary Obesity Surgery Endolumenal. OBES SURG 29, 2287–2298 (2019). https://doi.org/10.1007/s11695-019-03865-w

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