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KMID : 1038120200530060686
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Clinical Endoscopy
2020 Volume.53 No. 6 p.686 ~ p.697
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Effect of Aspiration Therapy on Obesity-Related Comorbidities: Systematic Review and Meta-Analysis
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Jirapinyo Pichamol
de Moura Diogo T. H.
Horton Laura C.
Thompson Christopher C.
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Abstract
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Background/Aims: Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities.
Methods: A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs).
Results: Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 ? -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 ? 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 ? -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7?6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 ? -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 ? -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 ? -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p<0.0001 for all). Subgroup analysis of 2 randomized controlled trials (n=225) showed that AT patients lost more weight than did controls by 11.6 (6.5?16.7) %TWL and 25.6 (16.0?35.3) %EWL and experienced greater improvement in HbA1c and alanine transaminase by 1.3 (0.8?1.8) % and 9.0 (3.9?14.0) U/L. The pooled SAE rate was 4.1%.
Conclusions: Obesity-related comorbidities significantly improved at 1 year following AT. Additionally, a subgroup of patients who continued to use AT appeared to experience significant weight loss that persisted up to at least 4 years.
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KEYWORD
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Aspiration therapy, AspireAssist, Bariatric endoscopy, Comorbidities, Obesity
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