Khushboo Gala, MBBS, Raseen Tariq, MBBS, Wissam Ghusn, MD, Andres Acosta, MD, PhD Mayo Clinic, Rochester, MN
Introduction: Management of obesity often requires a multimodality approach. Endoscopic bariatric therapies (EBTs) including intragastric balloons (IGB) and endoscopic sleeve gastroplasty (ESG) are new therapeutic modalities, that have shown to result in significant weight loss. Addition of antiobesity medications (AOMs) to EBTs may help with weight recrudescence or enhance weight loss. We performed a systematic review and meta-analysis to review the efficacy and safety of use of AOMs with EBTs.
Methods: A systematic search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus was performed from each database's inception to November 18, 2022. Main outcomes of interest were 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 the cases (EBT and AOM) and controls (EBT only). We also reported adverse events.
Results: Eight studies (5 full-text articles and 3 abstracts; 4 prospective studies and 4 retrospective reviews) including 560 patients were included, with follow-up ranging from 6-12 months. Six studies examined IGB (2 with IGB followed by AOM and 4 with IGB and concurrent AOM), and two examined ESG and concurrent AOM use. AOMs used included liraglutide only (4 studies), semaglutide only (1 study), sibutramine only (1 study), metformin (1 study), and multiple FDA-approved AOMs in 2 studies. %TBWL at 6 months was compared between cases and controls, and a pooled mean difference of 1.68 (95% CI -0.41, 3.77, p < 0.01) with high heterogeneity (I2 = 96%) (figure 1). Only two studies compared variations in %TBWL with different doses of AOMs, and both showed no statistical significance. AOMs were generally well tolerated. 5 major adverse events were described (3 early removals of IGB, 1 migration of IGB and 1 pneumoperitoneum related to ESG). By applying the GRADE methodology, the quality of evidence for outcomes was very low.
Discussion: AOMs may enhance weight loss outcomes after EBTs. Large scale randomized clinical trials will help to establish the true utility of a combination weight loss approach.
Figure: Figure 1: Forest Plot, Weight Loss Outcomes at 6 Months
Disclosures:
Khushboo Gala indicated no relevant financial relationships.
Raseen Tariq indicated no relevant financial relationships.
Wissam Ghusn indicated no relevant financial relationships.
Andres Acosta: Amgen Pharmaceuticals – Consultant. General Mills – Consultant. Gila Therapeutics – Stock-privately held company. Phenomix Sciences – Stock-privately held company. Rhythm Pharmaceuticals – Consultant.
Khushboo Gala, MBBS, Raseen Tariq, MBBS, Wissam Ghusn, MD, Andres Acosta, MD, PhD. P2623 - Use of Antiobesity Medications With Endoscopic Bariatric Therapies: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
