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Nunes BCM, de Moura DTH, Kum AST, de Oliveira GHP, Hirsch BS, Ribeiro IB, Gomes ILC, de Oliveira CPM, Mahmood S, Bernardo WM, de Moura EGH. Impact of Endoscopic Sleeve Gastroplasty in Non-alcoholic Fatty Liver Disease: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:2917-2926. [PMID: 37537506 DOI: 10.1007/s11695-023-06747-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023] [Imported: 08/29/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. Endoscopic sleeve gastroplasty (ESG) has proven to be feasible, safe, and effective in the management of obesity. We performed the first systematic review and meta-analysis evaluating NAFLD and other metabolic parameters 12 months post-ESG. Four observational studies with a total of 175 patients were included. The results showed a significant (p < 0.05) reduction of 4.85 in hepatic steatosis index (95% CI - 6.02, - 3.67), 0.5 in NAFLD fibrosis score (95% CI - 0.80, - 0.19), 6.32 U/l in ALT (95% CI - 9.52, - 3.11), 17.28% in TWL (95% CI - 18.24, - 16.31), 6.31 kg/m2 in BMI (95% CI - 8.11, - 4.52), 47.97% in EWL (95% CI - 49.10, - 46.84), and 0.51% in HbA1c (95% CI - 0.90, - 0.12). ESG improves liver parameters, provides weight loss, and reduces HbA1c levels in patients suffering from NAFLD.
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da Ponte Neto AM, Clemente ACO, Rosa PW, Ribeiro IB, Funari MP, Nunes GC, Moreira L, Sparvoli LG, Cortez R, Taddei CR, Mancini MC, de Moura EGH. Fecal microbiota transplantation in patients with metabolic syndrome and obesity: A randomized controlled trial. World J Clin Cases 2023; 11:4612-4624. [PMID: 37469721 PMCID: PMC10353513 DOI: 10.12998/wjcc.v11.i19.4612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/26/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Metabolic syndrome is a multifactorial disease, and the gut microbiota may play a role in its pathogenesis. Obesity, especially abdominal obesity, is associated with insulin resistance, often increasing the risk of type two diabetes mellitus, vascular endothelial dysfunction, an abnormal lipid profile, hypertension, and vascular inflammation, all of which promote the development of atherosclerotic cardiovascular disease.
AIM To evaluate the outcomes of fecal microbiota transplantation (FMT) in patients with metabolic syndrome.
METHODS This was a randomized, single-blind placebo-controlled trial comparing FMT and a sham procedure in patients with metabolic syndrome. We selected 32 female patients, who were divided into eight groups of four patients each. All of the patients were submitted to upper gastrointestinal endoscopy. In each group, two patients were randomly allocated to undergo FMT, and the other two patients received saline infusion. The patients were followed for one year after the procedures, during which time anthropometric, bioimpedance, and biochemical data were collected. The patients also had periodic consultations with a nutritionist and an endocrinologist. The primary end point was a change in the gut microbiota.
RESULTS There was evidence of a postprocedural change in microbiota composition in the patients who underwent FMT in relation to that observed in those who underwent the sham procedure. However, we found no difference between the two groups in terms of the clinical parameters evaluated.
CONCLUSION There were no significant differences in biochemical or anthropometric parameters, between the two groups evaluated. Nevertheless, there were significant postprocedural differences in the microbiota composition between the placebo group. To date, clinical outcomes related to FMT remain uncertain.
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Sakai CM, Ueda SKN, Caiado AHM, Ribeiro IB, Marinho FRT, de Rezende DT, Bustamante-Lopez LA, Nahas SC, de Moura DTH, de Moura EGH. A Head-to-Head Comparison of Computed Tomography Colonography, Optical Colonoscopy, and Colon Endoscopic Capsule for the Detection of Polyps After Partial Colectomy or Rectosigmoidectomy for Colorectal Cancer: A Pilot Study. Cureus 2023; 15:e38410. [PMID: 37273390 PMCID: PMC10232294 DOI: 10.7759/cureus.38410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 06/06/2023] [Imported: 08/29/2023] Open
Abstract
Background and objective Optical colonoscopy is the gold standard method for the diagnosis of colorectal cancer (CRC) and it allows for biopsy and resection, as well as documentation of synchronous lesions. CT colonography (CTC) and colon endoscopic capsule (CEC) are also recommended as alternative minimally invasive or non-invasive procedures. Prospective studies comparing these three approaches are scarce in the current literature. In light of this, the aim of this pilot study was to compare the efficacy of polyp detection between these three methods in patients with a history of curative surgical resection of CRC. Methods Patients were consecutively recruited and all procedures were sequentially conducted on the same day. The primary endpoint was the detection rate of polyps, whereas secondary endpoints were the detection of polyps according to size and location, and the adverse events caused by these procedures. Results A total of 21 patients were consecutively included and all of them underwent all three interventions. No adverse events, local recurrences, or metachronous lesions were detected. In two cases with elevated carcinoembryonic antigen (CEA), CTC unveiled distant metastasis. Optical colonoscopy registered a mean of 0.4 polyp >6 mm and 1.3 polyps <6 mm per patient. CTC unveiled only 0.5 polyp >6 mm/patient and no smaller lesions were documented, whereas findings for the colon capsule comprised an average of 0.4 polyps >6 mm and 0.7 polyps <6 mm per patient. Statistical difference was not demonstrated, except for virtual colonoscopy in terms of the total number of polyps detected in comparison to optical colonoscopy. Conclusions Optical colonoscopy showed superior results in comparison to virtual colonoscopy while there was no statistical difference in comparison to colon capsule. Notwithstanding occasional difficulties, all three techniques were well tolerated. Hence, decisions concerning the use of each diagnostic method should be based on their availability, professional expertise, contraindications, and patient preferences.
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Yvamoto EY, Cheng S, de Oliveira GHP, Sasso JGRJ, Boghossian MB, Minata MK, Ribeiro IB, de Moura EGH. Endoscopic Ultrasound View of Pneumatosis Cystoides Intestinalis. Diagnostics (Basel) 2023; 13:diagnostics13081424. [PMID: 37189527 DOI: 10.3390/diagnostics13081424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] [Imported: 08/29/2023] Open
Abstract
Pneumatosis cystoid intestinalis (PCI) is a rare condition, with a worldwide incidence of 0.3-1.2%. PCI is classified into primary (idiopathic) and secondary forms, with 15% and 85% of presentations, respectively. This pathology was associated with a wide variety of underlining etiologies to explain the abnormal accumulation of gas within the submucosa (69.9%), subserosa (25.5%), or both layers (4.6%). Many patients endure misdiagnosis, mistreatment, or even inadequate surgical exploration. In this case, a patient presented acute diverticulitis, after treatment, a control colonoscopy was performed that found multiple rounds and elevated lesions. To further study the subepithelial lesion (SEL), a colorectal endoscopic ultrasound (EUS) was performed with an overtube in the same procedure. For safe insertion of the curvilinear array EUS, an overtube with colonoscopy was positioned through the sigmoid as described by Cheng et al. The EUS evaluation evidenced air reverberation in the submucosal layer. The pathological analysis was consistent with PCI's diagnosis. The diagnosis of PCI is usually made by colonoscopy (51.9%), surgery (40.6%), and radiological findings (10.9%). Although the diagnosis can be made by radiological studies, a colorectal EUS and colonoscopy can be made in the same section without radiation and with high precision. As it is a rare disease, there are not enough studies to define the best approach, although colorectal EUS should be preferred for a reliable diagnosis.
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Lera Dos Santos ME, Proença IM, de Moura DTH, Ribeiro IB, Matuguma SE, Cheng S, de Freitas Júnior JR, Luz GDO, McCarty TR, Jukemura J, de Moura EGH. Self-Expandable Metal Stent (SEMS) Versus Lumen-Apposing Metal Stent (LAMS) for Drainage of Pancreatic Fluid Collections: A Randomized Clinical Trial. Cureus 2023; 15:e37731. [PMID: 37214030 PMCID: PMC10191807 DOI: 10.7759/cureus.37731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 05/23/2023] [Imported: 08/29/2023] Open
Abstract
Background and aim Endoscopic ultrasound (EUS)-guided drainage is the gold standard approach for the treatment of encapsulated pancreatic collections (EPCs) including pseudocyst and walled-off pancreatic necrosis (WON), and is associated with an equivalent clinical efficacy to surgical drainage with fewer complications and less morbidity. Drainage may be achieved via several types of stents including a fully covered self-expandable metallic stent (SEMS) and lumen-apposing metal stent (LAMS). However, to date there have been no randomized trials to compare these devices. This study aimed to compare the efficacy and safety of the SEMS versus LAMS for EUS-guided drainage of EPCs. Methods A phase IIB randomized trial was designed to compare the SEMS versus LAMS for the treatment of EPCs. Technical success, clinical success, adverse events (AEs), and procedure time were evaluated. A sample size of 42 patients was determined. Results There was no difference between the two groups in technical (LAMS 80.95% vs 100% SEMS, p=0.107), clinical (LAMS 85.71% vs 95.24% SEMS, p=0.606) or radiological success (LAMS 92.86% vs 83.33% SEMS, p=0.613). There was no difference in AEs including stent migration rate and mortality. The procedure time was longer in the LAMS group (mean time 43.81 min versus 24.43 min, p=0.001). There was also a difference in the number of intra-procedure complications (5 LAMS vs 0 SEMS, p=0.048). Conclusion SEMS and LAMS have similar technical, clinical, and radiological success as well as AEs. However, SEMS has a shorter procedure time and fewer intra-procedure complications compared to non-electrocautery-enhanced LAMS in this phase IIB randomized controlled trial (RCT). The choice of the type of stent used for EUS drainage of EPCs should consider device availability, costs, and personal and local experience.
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Yvamoto EY, de Moura DTH, Proença IM, do Monte Junior ES, Ribeiro IB, Ribas PHBV, Hemerly MC, de Oliveira VL, Sánchez-Luna SA, Bernardo WM, de Moura EGH. The Effectiveness and Safety of the Duodenal-Jejunal Bypass Liner (DJBL) for the Management of Obesity and Glycaemic Control: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Obes Surg 2023; 33:585-599. [PMID: 36508156 DOI: 10.1007/s11695-022-06379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/19/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022] [Imported: 08/29/2023]
Abstract
INTRODUCTION The duodenal-jejunal bypass liner (DJBL) is a less-invasive treatment of obesity and type 2 diabetes mellitus (T2DM). METHODS This is a systematic review and meta-analysis including randomized clinical trials (RCTs) comparing DJBL versus sham or pharmacotherapies aiming to evaluate the effectiveness and safety of DJBL. RESULTS Ten RCTs (681 patients) were included. The DJBL group showed superior excess weight loss (+ 11.4% [+ 7.75 to + 15.03%], p < 0.00001) and higher decrease in HbA1c compared to the control group (- 2.73 ± 0.5 vs. - 1.73 ± 0.4, p = 0.0001). Severe adverse events (SAEs) occurred in 19.7%. CONCLUSION The DJBL did not reach the ASGE/ASMBS thresholds for the treatment of obesity. However, it is important to state that many SAEs were not really severe. Therefore, we believe this therapy plays an important role in the management obesity and T2DM.
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Moll CF, de Moura DTH, Ribeiro IB, Proença IM, do Monte Junior ES, Sánchez-Luna SA, Merchán MFS, Intriago JMV, Bernardo WM, de Moura EGH. Endoscopic Biliary Darinage (EBD) versus Percutaneous Transhepatic Biliary Drainage (PTBD) for biliary drainage in patients with Perihilar Cholangiocarcinoma (PCCA): A systematic review and meta-analysis. Clinics (Sao Paulo) 2023; 78:100163. [PMID: 36681067 PMCID: PMC10757298 DOI: 10.1016/j.clinsp.2022.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/27/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023] [Imported: 08/29/2023] Open
Abstract
Biliary drainage for Perihilar Cholangiocarcinoma (PCCA) can be performed either by endoscopic retrograde cholangiopancreatography or Percutaneous Transhepatic Biliary Drainage (PTBD). To date there is no consensus about which method is preferred. Taking that into account, the aim of this study is to compare Endoscopic Biliary Drainage (EBD) versus percutaneous transhepatic biliary drainage in patients with perihilar cholangiocarcinoma through a systematic review and metanalysis. A comprehensive search of multiple electronic databases was performed. Evaluated outcomes included technical success, clinical success, post drainage complications (cholangitis, pancreatitis, bleeding, and major complications), crossover, hospital length stay, and seeding metastases. Data extracted from the studies were used to calculate Mean Differences (MD). Seventeen studies were included, with a total of 2284 patients (EBD = 1239, PTBD = 1045). Considering resectable PCCA, the PTBD group demonstrated lower rates of crossover (RD = 0.29; 95% CI 0.07‒0.51; p = 0.009 I² = 90%), post-drainage complications (RD = 0.20; 95% CI 0.06‒0.33; p < 0.0001; I² = 78%), and post-drainage pancreatitis (RD = 0.10; 95% CI 0.05‒0.16; p < 0.0001; I² = 64%). The EBD group presented reduced length of hospital stay (RD = -2.89; 95% CI -3.35 ‒ -2,43; p < 0.00001; I² = 42%). Considering palliative PCCA, the PTBD group demonstrated a higher clinical success (RD = -0.19; 95% CI -0.27 ‒ -0.11; p < 0.00001; I² = 0%) and less post-drainage cholangitis (RD = 0.08; 95% CI 0.01‒0.15; p = 0.02; I² = 48%) when compared to the EBD group. There was no statistical difference between the groups regarding: technical success, post-drainage bleeding, major post-drainage complications, and seeding metastases.
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Muacevic A, Adler JR, de Souza TF, Galvão Neto MDP, Grecco E, Waisberg J. Gastric Emptying and Its Correlation With Weight Loss and Body Mass Index in Patients With an Intragastric Balloon: A Prospective Study With Six Years of Follow-Up. Cureus 2022; 14:e32599. [PMID: 36654650 PMCID: PMC9840869 DOI: 10.7759/cureus.32599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] [Imported: 08/29/2023] Open
Abstract
Background Obesity is the most well-established and prolonged pandemic in modern society. Having a better understanding of the available tools is important to improve weight loss and make the strategies more productive. This study aims to evaluate the effect of intragastric balloon (IGB) on gastric emptying time, its relationship with weight loss after IGB removal, and weight maintenance after six years. Methodology This prospective study analyzed data from patients undergoing IGB placement. A six-years follow-up was performed and data about weight maintenance were collected. We analyzed the impact of the IGB on gastrointestinal motility and its correlation with weight loss. Results Of the 20 patients included in the study, 52.4% were diagnosed with class I obesity and 47.6% with class II obesity. The mean weight of the patients was 96.5 ± 11.9 kg at baseline, 79.6 ± 11.4 kg at the time of IGB removal, 81.8 ± 9.1 kg at six months, and 93.2 ± 14.3 kg six years after IGB removal. The mean difference between the initial weight and that measured immediately after IGB removal was 16.68 ± 5.71 kg. Regarding gastric emptying time, there was a difference in retention on comparing the measurement before balloon placement to that after the balloon was in place (72.9% vs. 86.8%) after one hour of food intake. Comparing two hours after food intake, patients before IGB placement had a 30.6% food retention, while patients with IGB in place had a 69.2% retention. Conclusions In patients with class I or II obesity, the use of an IGB delayed gastric emptying of foods but showed no direct correlation with weight loss. Weight loss achieved after IGB placement was maintained in half of the patients at a six-year follow-up.
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Sasso JGRJ, de Moura DTH, Proença IM, Junior ESDM, Ribeiro IB, Sánchez-Luna SA, Cheng S, Bestetti AM, Kum AST, Bernardo WM, de Moura EGH. Anti-reflux versus conventional self-expanding metal stents in the palliation of esophageal cancer: A systematic review and meta-analysis. Endosc Int Open 2022; 10:E1406-E1416. [PMID: 36262514 PMCID: PMC9576338 DOI: 10.1055/a-1894-0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022] [Imported: 08/29/2023] Open
Abstract
Background and study aims Self-expanding metal stents (SEMS) are an effective palliative endoscopic therapy to reduce dysphagia in esophageal cancer. Gastroesophageal reflux disease (GERD) is a relatively common complaint after non-valved conventional SEMS placement. Therefore, valved self-expanding metal stents (SEMS-V) were designed to reduce the rate of GERD symptoms. We aimed to perform a systematic review and meta-analysis comparing the two stents. Material and methods This was a systematic review and meta-analysis including only randomized clinical trials (RCT) comparing the outcomes between SEMS-V and non-valved self-expanding metal stents (SEMS-NV) following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were analyzed with Review Manager Software. Quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results Ten randomized clinical trials including a total of 467 patients, 234 in the SEMS-V group and 233 in the SEMS-NV group, were included. There were no statistically significant differences regarding GERD qualitative analysis (RD -0.17; 95 % CI -0.67, 0.33; P = 0.5) and quantitative analysis (SMD -0.22; 95 % CI -0.53, 0.08; P = 0.15) technical success (RD -0.03; 95 % CI -0.07, 0.01; P = 0.16), dysphagia improvement (RD -0.07; 95 % CI -0.19, 0.06; P = 0.30), and adverse events (RD 0.07; 95 % CI -0.07, 0.20; P = 0.32). Conclusions Both SEMS-V and SEMS-NV are safe and effective in the palliation of esophageal cancer with similar rates of GERD, dysphagia relief, technical success, adverse events, stent migration, stent obstruction, bleeding, and improvement of the quality of life.
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de Moura ETH, Jukemura J, Ribeiro IB, Farias GFA, de Almeida Delgado AA, Coutinho LMA, de Moura DTH, Aissar Sallum RA, Nasi A, Sánchez-Luna SA, Sakai P, de Moura EGH. Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial. World J Gastroenterol 2022; 28:4875-4889. [PMID: 36156932 PMCID: PMC9476850 DOI: 10.3748/wjg.v28.i33.4875] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/07/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy (POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy, has emerged as a promising minimally invasive technique for the management of this condition.
AIM To compare POEM and laparoscopic myotomy and partial fundoplication (LM-PF) regarding their efficacy and outcomes for the treatment of achalasia.
METHODS Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria (dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis (as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min (on a barium esophagogram), pressure at the LES, the occurrence of adverse events (AEs), length of stay (LOS), and quality of life (QoL).
RESULTS There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up (P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group (P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group (185.00 ± 56.89 and 95.70 ± 30.47 min vs 296.75 ± 56.13 and 218.75 ± 50.88 min, respectively; P = 0.001 for both). In the POEM group, there were improvements in all domains of the QoL questionnaire, whereas there were improvements in only three domains in the LM-PF group.
CONCLUSION POEM and LM-PF appear to be equally effective in controlling the symptoms of achalasia, shortening LOS, and minimizing AEs. Nevertheless, POEM has the advantage of improving all domains of QoL, and shortening anesthesia and procedure times but with a significantly higher rate of gastroesophageal reflux.
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Mancini FC, de Moura DTH, Funari MP, Ribeiro IB, Neto FLP, Mendieta PJO, McCarty TR, Bernardo WM, Nahas SC, de Moura EGH. Use of an electromagnetic-guided device to assist with post-pyloric placement of a nasoenteral feeding tube: A systematic review and meta-analysis. Endosc Int Open 2022; 10:E1118-E1126. [PMID: 36247074 PMCID: PMC9558487 DOI: 10.1055/a-1789-0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/01/2021] [Indexed: 11/15/2022] [Imported: 08/29/2023] Open
Abstract
Background and study aims While endoscopic-guided placement (EGP) of a post-pyloric nasoenteral feeding tube may improve caloric intake and reduce the risk of bronchoaspiration, an electromagnetic-guided placement (EMGP) method may obviate the need for endoscopic procedures. Therefore, the primary aim of this study was to perform a systematic review and meta-analysis of randomized trials comparing the efficacy and safety of EMGP versus EGP of a post-pyloric feeding tube. Methods Protocolized searches were performed from the inception through January 2021 following PRISMA guidelines. Only randomized controlled trials were included comparing EMGP versus EGP. Study outcomes included: technical success (defined as appropriate post-pyloric positioning), tube and patient associated adverse events (AEs), time to enteral nutrition, procedure-associated cost, and procedure time. Pooled risk difference (RD) and mean difference (MD) were calculated using a fixed-effects model and heterogeneity evaluated using Higgins test (I 2 ). Results Four randomized trials (n = 536) were included. A total of 287 patients were included in the EMGP group and 249 patients in the EGP group. There was no difference between EMGP versus EGP regarding technical success, tube-related AEs, patient-related AEs, procedure time, and time in the right position. Time to enteral nutrition favored EMGP (MD: -134.37 [-162.13, -106.61]; I 2 = 35 %); with significantly decreased associated cost (MD: -127.77 ($) [-135.8-119.73]; I 2 = 0 %). Conclusions Based on this study, EMGP and EGP were associated with similar levels of technical success and safety as well as time to complete the procedure. Despite this, EMGP was associated with reduced cost and time to initiation of nutrition.
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Intriago JMV, de Moura DTH, do Monte Junior ES, Proença IM, Ribeiro IB, Sánchez-Luna SA, Bernardo WM, de Moura EGH. Endoscopic Vacuum Therapy (EVT) for the Treatment of Post-Bariatric Surgery Leaks and Fistulas: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:3435-3451. [PMID: 35918596 DOI: 10.1007/s11695-022-06228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 11/26/2022] [Imported: 08/29/2023]
Abstract
Bariatric surgery remains the most effective treatment for morbid obesity and its comorbidities. However, post-surgical leaks and fistulas can occur in about 1-5% of patients, with challenging treatment approaches. Endoscopic vacuum therapy (EVT) has emerged as a promising tool due to its satisfactory results and accessibility. In this first systematic review and meta-analysis on the subject, EVT revealed rates of 87.2% clinical success, 6% moderate adverse events, and 12.5% system dislodgements, requiring 6.47 EVT system exchanges every 4.39 days, with a dwell time of 25.67 days and a total length of hospitalization of 44.43 days. Although our results show that EVT is a safe and effective therapy for post-surgical leaks and fistulas, they should be interpreted with caution due to the paucity of available data.
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de Figueiredo VLP, Ribeiro IB, de Moura DTH, Oliveira CC, de Moura EGH. Mucosa-associated lymphoid tissue lymphoma in the terminal ileum: A case report. World J Gastrointest Endosc 2022; 14:177-183. [DOI: 10.4253/wjge.v14.i3.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND The lymphoma of the mucosa-associated lymphoid tissue (MALT) is predominantly found in the stomach. The few cases reported in the literature of MALT lymphomas affecting the ileum are in patients who are already symptomatic and with clear advanced endoscopic findings. We present the first case of an asymptomatic female patient who underwent colonoscopy as a routine examination with the findings of an ulcer in the distal ileum region, which histopathological examination and associated immunohistochemistry revealed the diagnosis of MALT lymphoma.
CASE SUMMARY A 57-year-old asymptomatic female patient underwent a colonoscopy exam for screening. The examination revealed an ulcer of medium depth with well-defined borders covered by a thin layer of fibrin and a halo of hyperemia in the distal ileum portion. Findings are nonspecific but may signal infections by viruses, protozoa, and parasites or inflammatory diseases such as Crohn's disease. Biopsies of the ulcer were taken. The anatomopathological result revealed an atypical diffuse lymphocytic infiltrate of small cells with a characteristic cytoplasmic halo of marginal zone cells. The immunohistochemical study was performed and the results demonstrated a negative neoplastic infiltrate for the expression of cyclin D1 and cytokeratin AE1/AE3 and a positive for BCL60 in the germinal center. The test also revealed CD10 positivity in the glandular epithelium and germinal center of a reactive follicle with dual-labeling of CD20 and CD3 demonstrating the B lymphocyte nature of the neoplastic infiltrate. In BCL2 protein labeling, the neoplastic infiltrate is strongly positive with a negative germinal center. The findings are consistent with immunophenotype B non-Hodgkin's lymphoma, better classified as extranodal MALT. The patient was treated with chemotherapy and showed complete regression of the disease, as evidenced by colonoscopy performed after treatment.
CONCLUSION MALT lymphomas in the terminal ileum are extremely rare and only 4 cases have been reported in the literature. Given the low sensitivity and specificity of endoscopic images in these cases, the pathology can be confused with other important differential diagnoses such as inflammatory diseases or infectious diseases and which makes the biopsy important, even in asymptomatic patients, paired with anatomopathological analysis and immunohistochemistry which is the gold standard for correct diagnosis.
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de Figueiredo VLP, Ribeiro IB, de Moura DTH, Oliveira CC, de Moura EGH. Mucosa-associated lymphoid tissue lymphoma in the terminal ileum: A case report. World J Gastrointest Endosc 2022; 14:176-182. [PMID: 35432742 PMCID: PMC8984533 DOI: 10.4253/wjge.v14.i3.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/05/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND The lymphoma of the mucosa-associated lymphoid tissue (MALT) is predominantly found in the stomach. The few cases reported in the literature of MALT lymphomas affecting the ileum are in patients who are already symptomatic and with clear advanced endoscopic findings. We present the first case of an asymptomatic female patient who underwent colonoscopy as a routine examination with the findings of an ulcer in the distal ileum region, which histopathological examination and associated immunohistochemistry revealed the diagnosis of MALT lymphoma.
CASE SUMMARY A 57-year-old asymptomatic female patient underwent a colonoscopy exam for screening. The examination revealed an ulcer of medium depth with well-defined borders covered by a thin layer of fibrin and a halo of hyperemia in the distal ileum portion. Findings are nonspecific but may signal infections by viruses, protozoa, and parasites or inflammatory diseases such as Crohn's disease. Biopsies of the ulcer were taken. The anatomopathological result revealed an atypical diffuse lymphocytic infiltrate of small cells with a characteristic cytoplasmic halo of marginal zone cells. The immunohistochemical study was performed and the results demonstrated a negative neoplastic infiltrate for the expression of cyclin D1 and cytokeratin AE1/AE3 and a positive for BCL60 in the germinal center. The test also revealed CD10 positivity in the glandular epithelium and germinal center of a reactive follicle with dual-labeling of CD20 and CD3 demonstrating the B lymphocyte nature of the neoplastic infiltrate. In BCL2 protein labeling, the neoplastic infiltrate is strongly positive with a negative germinal center. The findings are consistent with immunophenotype B non-Hodgkin's lymphoma, better classified as extranodal MALT. The patient was treated with chemotherapy and showed complete regression of the disease, as evidenced by colonoscopy performed after treatment.
CONCLUSION MALT lymphomas in the terminal ileum are extremely rare and only 4 cases have been reported in the literature. Given the low sensitivity and specificity of endoscopic images in these cases, the pathology can be confused with other important differential diagnoses such as inflammatory diseases or infectious diseases and which makes the biopsy important, even in asymptomatic patients, paired with anatomopathological analysis and immunohistochemistry which is the gold standard for correct diagnosis.
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Lera Dos Santos ME, Ribeiro IB, Proença IM, de Souza GMV, de Moura DTH, Matuguma SE, de Moura EGH. Endoscopic transgastric cholecystectomy during direct endoscopic necrosectomy for walled-off necrosis of the pancreas. Endoscopy 2022; 54:E79-E80. [PMID: 33723843 DOI: 10.1055/a-1388-6254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 08/29/2023]
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de Moura DTH, Dantas ACB, Ribeiro IB, McCarty TR, Takeda FR, Santo MA, Nahas SC, de Moura EGH. Status of bariatric endoscopy–what does the surgeon need to know? A review. World J Gastrointest Surg 2022; 14:185-199. [PMID: 35317547 PMCID: PMC8908340 DOI: 10.4240/wjgs.v14.i2.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/14/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Obesity is a chronic and multifactorial disease with a variety of potential treatment options available. Currently, there are several multidisciplinary therapeutic options for its management, including conservative, endoscopic, and surgical treatment.
AIM To clarify indications, technical aspects, and outcomes of bariatric endoscopy.
METHODS Narrative review of current literature based on electronic databases including MEDLINE (PubMed), Cochrane Library, and SciELO.
RESULTS Bariatric endoscopy is in constant development and comprises primary and revisional treatment options as well as management of surgical complications. Various devices act upon different mechanisms of action, which may be individualized to each patient. Despite favorable results for the endoscopic treatment of obesity, prospective randomized studies with long-term follow-up are required to fully validate primary and revisional endoscopic therapies. Regarding the management of bariatric surgery complications, endoscopic therapy may be considered the procedure of choice in a variety of situations. Still, as there is no standardized algorithm, local experience should be considered in decision-making.
CONCLUSION The treatment of patients with obesity is complex, and a multidisciplinary approach is essential. Bariatric endoscopy has shown impressive results both in the treatment of obesity and its surgical complications, and therefore, must be part of the armamentarium in the fight against this disease.
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Funari MP, Ribeiro IB, Lera Dos Santos ME, Matuguma SE, de Moura EGH. Managing adverse events after endoscopic ultrasound-guided drainage of the biliary tract and pancreatic fluid collections: Narrative review (with video). Dig Endosc 2022; 34:359-366. [PMID: 34245627 DOI: 10.1111/den.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023] [Imported: 08/29/2023]
Abstract
Endoscopic ultrasound (EUS)-guided therapeutic procedures have become increasingly common in clinical practice. The development of EUS-guided fine needle aspiration cytology led to the concept of interventional EUS. However, it carries a considerable risk of adverse events (AEs), which occur in approximately 23% of the procedures performed for the drainage of pancreatic fluid collections and 2.5-37.0% of those performed for drainage of the biliary tract. Although the vast majority of AEs occurring after EUS-guided drainage are mild, a deep understanding of such events is necessary for their appropriate management. Because EUS-guided drainage is a novel procedure, there have been few studies of the topic. To our knowledge, this is the first narrative review that focuses on the management and resolution of AEs occurring after EUS-guided drainage of pancreatic fluid collections or the biliary tract. We also include an explanatory video.
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Moura DTH, McCarty TR, Jirapinyo P, Ribeiro IB, Farias GFA, Madruga-Neto AC, Ryou M, Thompson CC. Endoscopic ultrasound fine needle aspiration vs fine needle biopsy in solid lesions: A multi-center analysis. World J Clin Cases 2021; 9:10507-10517. [PMID: 35004982 PMCID: PMC8686153 DOI: 10.12998/wjcc.v9.i34.10507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/24/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND While endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is considered a preferred technique for tissue sampling for solid lesions, fine needle biopsy (FNB) has recently been developed.
AIM To compare the accuracy of FNB vs FNA in determining the diagnosis of solid lesions.
METHODS A retrospective, multi-center study of EUS-guided tissue sampling using FNA vs FNB needles. Measured outcomes included diagnostic test characteristics (i.e., sensitivity, specificity, accuracy), use of rapid on-site evaluation (ROSE), and adverse events. Subgroup analyses were performed by type of lesion and diagnostic yield with or without ROSE. A multivariable logistic regression was also performed.
RESULTS A total of 1168 patients with solid lesions (n = 468 FNA; n = 700 FNB) underwent EUS-guided sampling. Mean age was 65.02 ± 12.13 years. Overall, sensitivity, specificity and accuracy were superior for FNB vs FNA (84.70% vs 74.53%; 99.29% vs 96.62%; and 87.62% vs 81.55%, respectively; P < 0.001). On subgroup analyses, sensitivity, specificity, and accuracy of FNB alone were similar to FNA + ROSE [(81.66% vs 86.45%; P = 0.142), (100% vs 100%; P = 1.00) and (88.40% vs 85.43%; P = 0.320]. There were no difference in diagnostic yield of FNB alone vs FNB + ROSE (P > 0.05). Multivariate analysis showed no significant predictor for better accuracy. On subgroup analyses, FNB was superior to FNA for non-pancreatic lesions; however, there was no difference between the techniques among pancreatic lesions. One adverse event was reported in each group.
CONCLUSION FNB is superior to FNA with equivalent diagnostic test characteristics compared to FNA + ROSE in the diagnosis of non-pancreatic solid lesions. Our results suggest that EUS-FNB may eliminate the need of ROSE and should be employed as a first-line method in the diagnosis of solid lesions.
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Sagae VMT, Ribeiro IB, da Ponte Neto AM, Matuguma SE, Cheng S, Lera Dos Santos ME, de Moura EGH. The feared postdilation complication in caustic esophageal stenosis: combined endoscopic and surgical treatment. Endoscopy 2021; 53:E446-E447. [PMID: 33506467 DOI: 10.1055/a-1339-0588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 08/29/2023]
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Ribeiro IB, Luz GDO, de Souza GMV, Boghossian MB, do Monte Junior ES, Dos Santos MEL, de Moura EGH. Acute esophageal necrosis (black esophagus) with active upper gastrointestinal bleeding: What to do? Endoscopy 2021; 53:E468-E469. [PMID: 33540443 DOI: 10.1055/a-1346-8343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 08/29/2023]
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Ribeiro IB, de Moura DTH, de Moura EGH. Gastrointestinal symptoms in patients with COVID-19: Is there a relationship with mortality and new variations of SARS-CoV-2? World J Gastroenterol 2021; 27:6345-6347. [PMID: 34712037 PMCID: PMC8515800 DOI: 10.3748/wjg.v27.i37.6345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although, respiratory symptoms are typical the digestive system is also a susceptible target with gastrointestinal symptoms present even in the absence of respiratory symptoms. The gastrointestinal symptoms of COVID-19 include diarrhea, abdominal pain, anorexia, and nausea among other symptoms. Some questions that remain to be answered include: Do patients with gastrointestinal symptoms have a higher mortality? SARS-CoV-2 variants are already a global reality: Do these variants present with a greater prevalence of gastrointestinal symptoms? Do patients with these symptoms warrant more intensive care unit care?
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do Monte Junior ES, de Moura DTH, Ribeiro IB, Hathorn KE, Farias GFA, Turiani CV, Medeiros FS, Bernardo WM, de Moura EGH. Endoscopic vacuum therapy versus endoscopic stenting for upper gastrointestinal transmural defects: Systematic review and meta-analysis. Dig Endosc 2021; 33:892-902. [PMID: 33300634 DOI: 10.1111/den.13813] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/30/2020] [Accepted: 08/12/2020] [Indexed: 02/08/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND Upper gastrointestinal fistulas, leaks, and perforations represent a high cost burden to health systems worldwide, with high morbidity and mortality rates for affected patients. Management of these transmural defects remains therapeutically challenging. OBJECTIVES The aim of this study is to perform a systematic review and meta-analysis to investigate the efficacy and safety of self-expanding metal stents (SEMS) versus endoscopic vacuum therapy (EVT) for treatment of upper gastrointestinal transmural defects. METHODS Searches were performed on MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health (LILACS), and gray literature, as well as a manual search to identify studies comparing SEMS versus EVT to treat upper gastrointestinal transmural defects. Evaluated outcomes were: rates of successful closure, mortality, length of hospital stay, duration of treatment, and adverse events. RESULTS Five studies with a total of 274 patients were included. There was a 21% increase in successful fistula closure attributed to EVT compared with the SEMS group (RD 0.21, CI 0.10-0.32; P = 0.0003). EVT demonstrated a 12% reduction in mortality compared to stenting (RD 0.12, CI 0.03-0.21; P = 0.006) and an average reduction of 14.22 days in duration of treatment (CI 8.38-20.07; P < 0.00001). There was a 24% reduction in adverse events (RD 0.24, CI 0.13-0.35; P = 0.0001. There were no statistical differences between the studied therapies regarding the length of hospital stay. CONCLUSION Endoscopic vacuum therapy proves to be superior in successful defect closure, mortality, adverse events and duration of treatment.
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Silvino do Monte E, Ide E, Sagae VMT, Ribeiro IB, Funari MP, de Oliveira PVAG, de Moura EGH. Endoscopic stag beetle knife treatment for symptomatic Zenker's diverticulum. Endoscopy 2021; 53:E318-E319. [PMID: 33075827 DOI: 10.1055/a-1273-7390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022] [Imported: 08/29/2023]
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Ponte Neto FL, de Moura DTH, Sagae VMT, Ribeiro IB, Mancini FC, Boghossian MB, McCarty TR, Miyajima NT, Ide E, Bernardo WM, de Moura EGH. Endoscopic resection of esophageal and gastric submucosal tumors from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation: A systematic review and meta-analysis. Surg Endosc 2021; 35:6413-6426. [PMID: 34415431 DOI: 10.1007/s00464-021-08659-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022] [Imported: 08/29/2023]
Abstract
BACKGROUND Submucosal tunneling endoscopic resection (STER) and endoscopic submucosal excavation (ESE) are less-invasive therapeutic alternatives to surgical resection for the removal of esophageal or gastric submucosal tumors (SMTs). This study aimed to comparing STER versus ESE for the resection of esophageal and gastric SMTs from the muscularis propria. METHODS This systematic review and meta-analysis was reported in accordance with PRISMA guidelines through December 2020. Pooled outcome measures included complete resection, en bloc resection, bleeding, perforation, adverse events, recurrence, procedure duration, and length of hospital stay. Risk ratio (RR) and mean difference (MD) was calculated as well as Peto time-to-event analyses to determine recurrence rate. RESULTS Five retrospective cohort studies (n = 269 STER versus n = 319 ESE) were included. There was no difference in rates of complete resection [RR: 1.01 (95% CI 0.94, 1.07)], en bloc resection [RR: 0.95 (95% CI 0.84, 1.08)], recurrence [OR: 1.18 (95% CI 0.33, 4.16)], and total adverse events [RR: 1.33 (95% CI 0.78, 2.27)]. Specific adverse events including rates of perforation [RR: 0.57 (95% CI 0.12, 2.74)] and bleeding [RR: 1.21 (95% CI 0.30, 4.88)] were not different between STER and ESE. There was a statistical difference when evaluating procedure time, with the STER group presenting significantly larger values [MD: 24.62 min (95% CI 20.04, 29.20)]. CONCLUSION STER and ESE were associated with similar efficacy and safety; however, ESE was associated with a significantly decreased time to complete the procedure.
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de Freitas Júnior JR, Ribeiro IB, de Moura DTH, Sagae VMT, de Souza GMV, de Oliveira GHP, Sánchez-Luna SA, de Souza TF, de Moura ETH, de Oliveira CPMS, Bernardo WM, de Moura EGH. Effects of intragastric balloon placement in metabolic dysfunction-associated fatty liver disease: A systematic review and meta-analysis. World J Hepatol 2021; 13:815-829. [PMID: 34367502 PMCID: PMC8326158 DOI: 10.4254/wjh.v13.i7.815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/12/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND Metabolic dysfunction-associated fatty liver disease corresponds to a clinical entity that affects liver function triggered by the accumulation of fat in the liver and is linked with metabolic dysregulation.
AIM To evaluate the effects of the intragastric balloon (IGB) in patients with metabolic dysfunction-associated fatty liver disease through the assessment of liver enzymes, imaging and several metabolic markers.
METHODS A comprehensive search was done of multiple electronic databases (MEDLINE, EMBASE, LILACS, Cochrane and Google Scholar) and grey literature from their inception until February 2021. Inclusion criteria involved patients with a body mass index > 25 kg/m2 with evidence or previous diagnosis of hepatic steatosis. Outcomes analyzed before and after 6 mo of IGB removal were alanine aminotransferase (IU/L), gamma-glutamyltransferase (IU/L), glycated hemoglobin (%), triglycerides (mg/dL), systolic blood pressure (mmHg), homeostatic model assessment, abdominal circumference (cm), body mass index (kg/m2) and liver volume (cm3).
RESULTS Ten retrospective cohort studies evaluating a total of 508 patients were included. After 6 mo of IGB placement, this significantly reduced alanine aminotransferase [mean difference (MD): 10.2, 95% confidence interval (CI): 8.12-12.3], gamma-glutamyltransferase (MD: 9.41, 95%CI: 6.94-11.88), glycated hemoglobin (MD: 0.17%, 95%CI: 0.03-0.31), triglycerides (MD: 38.58, 95%CI: 26.65-50.51), systolic pressure (MD: 7.27, 95%CI: 4.79-9.76), homeostatic model assessment (MD: 2.23%, 95%CI: 1.41-3.04), abdominal circumference (MD: 12.12, 95%CI: 9.82-14.41) and body mass index (MD: 5.07, 95%CI: 4.21-5.94).
CONCLUSION IGB placement showed significant efficacy in improving alanine aminotransferase and gamma-glutamyltransferase levels in patients with metabolic dysfunction-associated fatty liver disease as well as improving metabolic markers related to disease progression.
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