PMID- 32692991 OWN - NLM STAT- MEDLINE DCOM- 20210319 LR - 20210319 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 92 IP - 6 DP - 2020 Dec TI - Endoscopic full-thickness suturing plus argon plasma mucosal coagulation versus argon plasma mucosal coagulation alone for weight regain after gastric bypass: a systematic review and meta-analysis. PG - 1164-1175.e6 LID - S0016-5107(20)34564-8 [pii] LID - 10.1016/j.gie.2020.07.013 [doi] 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. CI - Copyright (c) 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. FAU - Jaruvongvanich, Veeravich AU - Jaruvongvanich V AD - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. FAU - Vantanasiri, Kornpong AU - Vantanasiri K AD - Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota. FAU - Laoveeravat, Passisd AU - Laoveeravat P AD - Department of Internal Medicine, Texas Tech University, Lubbock, Texas, USA. FAU - Matar, Reem H AU - Matar RH AD - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. FAU - Vargas, Eric J AU - Vargas EJ AD - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. FAU - Maselli, Daniel B AU - Maselli DB AD - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. FAU - Alkhatry, Maryam AU - Alkhatry M AD - Division of Gastroenterology, IBHO hospital, Ras Al Khaimah, United Arab Emirates. FAU - Fayad, Lea AU - Fayad L AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA. FAU - Kumbhari, Vivek AU - Kumbhari V AD - Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA. FAU - Fittipaldi-Fernandez, Ricardo Jose AU - Fittipaldi-Fernandez RJ AD - Department of Bariatric Endoscopy, Endogastro Rio Clinic, Rio de Janeiro, RJ, Brazil. FAU - Hollenbach, Marcus AU - Hollenbach M AD - Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology - University of Leipzig Medical Center, Leipzig, Germany. FAU - Watson, Rabindra R AU - Watson RR AD - Interventional Endoscopy Services, California Pacific Medical Center, University of California, San Francisco, San Francisco, California, USA. FAU - Gustavo de Quadros, Luiz AU - Gustavo de Quadros L AD - ABC Medical School, Santo Andre, Brazil. FAU - Galvao Neto, Manoel AU - Galvao Neto M AD - ABC Medical School, Santo Andre, Brazil. FAU - Aepli, Patrick AU - Aepli P AD - Gastroenterology and Hepatology Unit, Luzerner Kantonsspital, Lucerne, Switzerland. FAU - Staudenmann, Dominic AU - Staudenmann D AD - AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. FAU - Brunaldi, Vitor Ottoboni AU - Brunaldi VO AD - Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil. FAU - Storm, Andrew C AU - Storm AC AD - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. FAU - Martin, John A AU - Martin JA AD - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. FAU - Gomez, Victoria AU - Gomez V AD - Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA. FAU - Abu Dayyeh, Barham K AU - Abu Dayyeh BK AD - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. LA - eng PT - Comparative Study PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20200718 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 RN - 0 (Plasma Gases) SB - IM MH - *Argon Plasma Coagulation MH - *Gastric Bypass/adverse effects/methods MH - Gastroscopy MH - Humans MH - Jejunum/*surgery MH - Natural Orifice Endoscopic Surgery MH - *Obesity, Morbid/surgery MH - Plasma Gases/therapeutic use MH - Recurrence MH - Reoperation MH - Stomach/*surgery MH - Suture Techniques MH - Treatment Outcome MH - Weight Gain EDAT- 2020/07/22 06:00 MHDA- 2021/03/20 06:00 CRDT- 2020/07/22 06:00 PHST- 2020/04/30 00:00 [received] PHST- 2020/07/05 00:00 [accepted] PHST- 2020/07/22 06:00 [pubmed] PHST- 2021/03/20 06:00 [medline] PHST- 2020/07/22 06:00 [entrez] AID - S0016-5107(20)34564-8 [pii] AID - 10.1016/j.gie.2020.07.013 [doi] PST - ppublish SO - Gastrointest Endosc. 2020 Dec;92(6):1164-1175.e6. doi: 10.1016/j.gie.2020.07.013. Epub 2020 Jul 18.