Comparative efficacy of bariatric endoscopic procedures in the treatment of morbid obesity: a systematic review and network meta-analysis

Abstract

Background: The comparative efficacy of bariatric endoscopic procedures has not been completely elucidated. We aimed to comprehensively evaluate the efficacy of bariatric endoscopic procedures. Methods: We searched for randomized controlled trials investigating the efficacy of bariatric endoscopic procedures, including the use of an intragastric balloon, duodenal-jejunal bypass liner (DJBL), aspiration therapy, primary obesity surgery endoluminal (POSE) procedure, and botulinum toxin injection to the stomach. Network meta-analyses were performed to determine the percentage of weight loss (% weight loss) and percentage of excess weight loss (% EWL). Results: 22 studies with 2141 patients were included in the meta-analysis. Most endoscopic procedures showed superior efficacy in terms of %weight loss compared with the control (mean difference [MD] [95% confidence interval (CI)]: aspiration therapy 10.4% [7.0% to 13.7%]; fluid-filled balloon 5.3% [3.4% to 7.2 %]; POSE 4.9% [1.7% to 8.2%]; and DJBL 4.5% [1.4% to 7.7%]). In terms of %EWL, aspira-tion therapy, fluid-filled balloon, POSE, and DJBL were superior to the control ( MD [95%CI]: 27.3% [15.3% to 39.3%]; 22.4% [15.4% to 29.4%]; 15.3% [2.5% to 28.0%]; and 13.0% [4.9% to 21.2], respectively). The gas-filled balloon and botulinum toxin injection did not show a significant difference in %weight loss or %EWL compared with the control. For the fluid-filled balloon, the %EWL and %weight loss tended to decrease after balloon removal at 6 months after the procedure. Conclusion: All bariatric endoscopic procedures, except for gas-filled balloon and botulinum toxin injection to the stomach, showed superior short-term efficacy in terms of % weight loss or %EWL compared with lifestyle modification.