Skip to main content

Advertisement

SpringerLink
Log in

Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Primary obesity surgery endoluminal (POSE) utilizes an incision-less operating platform system to create full-thickness plications in the gastric fundus and body (original POSE). Many studies have demonstrated the safety and efficacy of original POSE for the treatment of obesity.

Objective

We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to evaluate the outcomes of original POSE per the ASGE task force thresholds.

Methods

Bibliographic databases were systematically searched for studies assessing the outcomes of POSE for the treatment of obesity. All randomized controlled trials (RCTs) and observational studies that assessed outcomes of POSE were included. Studies were included if they reported percent total weight loss (%TWL) or percent excess weight loss (%EWL) and the incidence of serious adverse events (SAE).

Results

A total of seven studies with 613 patients were included. Two included studies were RCTs, while the remaining were observational studies. Pooled mean %EWL at 3–6 months and 12–15 months were 42.62 (95% CI 37.56–47.68) and 48.86 (95% CI 42.31–55.41), respectively. Pooled mean %TWL at 3–6 months and 12–15 months was 13.45 (95% CI 8.93–17.97) and 12.68 (95% CI 8.13–17.23), respectively. Subgroup analysis of two RCTs showed that weight loss at 1 year was significantly higher in POSE patients (%EWL difference in means 19.45 (95% CI 4.65–34.24, p value = 0.01). The overall incidence of serious adverse events was only 2.84% and included GI bleeding, extra-gastric bleeding, hepatic abscess, severe pain, severe nausea, and severe vomiting. The mean number of total anchors placed in the fundus and body was 13.18 (95% CI 11.77–14.58), and the mean procedure time was 44.55 min (95% CI 36.44–52.65).

Conclusion

POSE, a minimally invasive endoscopic bariatric therapy, is a safe and effective modality for the treatment of obesity. The outcomes of POSE meet and surpass the ASGE joint task force thresholds. Future studies should evaluate newer versions of this procedure that emphasize gastric body plication sparing the fundus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. WHO. WHO | Overweight and obesity. WHO

  2. Ju T, Rivas L, Arnott S et al (2019) Barriers to bariatric surgery: factors influencing progression to bariatric surgery in a U.S. metropolitan area. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2018.12.004

    Article  PubMed  Google Scholar 

  3. Funk LM, Jolles S, Fischer LE, Voils CI (2015) Patient and referring practitioner characteristics associated with the likelihood of undergoing bariatric surgery a systematic review. JAMA Surg. https://doi.org/10.1001/jamasurg.2015.1250

    Article  PubMed  PubMed Central  Google Scholar 

  4. Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23:427–436

    Article  Google Scholar 

  5. Cohen RV, Oliveira da Costa MV, Charry L, Heins E (2019) Endoscopic gastroplasty to treat medically uncontrolled obesity needs more quality data: a systematic review. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2019.03.016

    Article  PubMed  PubMed Central  Google Scholar 

  6. Khan Z, Khan MA, Hajifathalian K et al (2019) Efficacy of endoscopic interventions for the management of obesity: a meta-analysis to compare endoscopic sleeve gastroplasty, AspireAssist, and primary obesity surgery endolumenal. Obes Surg 29(7):2287–2298. https://doi.org/10.1007/s11695-019-03865-w

    Article  PubMed  Google Scholar 

  7. Gys B, Plaeke P, Lamme B et al (2019) Endoscopic gastric plication for morbid obesity: a systematic review and meta-analysis of published data over time. Obes Surg. https://doi.org/10.1007/s11695-019-04010-3

    Article  PubMed  Google Scholar 

  8. Ginsberg GG, Chand B, Cote GA et al (2011) A pathway to endoscopic bariatric therapies. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2011.08.053

    Article  PubMed  Google Scholar 

  9. Chand B (2011) A pathway to endoscopic bariatric therapies: ASGE/ASMBS task force on endoscopic bariatric therapy. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2011.09.008

    Article  PubMed  Google Scholar 

  10. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. https://doi.org/10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  11. Espinós JC, Turró R, Mata A et al (2013) Early experience with the incisionless operating platformTM (iop) for the treatment of obesity: the primary obesity surgery endolumenal (pose) procedure. Obes Surg. https://doi.org/10.1007/s11695-013-0937-8

    Article  PubMed  Google Scholar 

  12. García RG, Velázquez JV (2019) Reinforced POSE: the 18-plication solution. Obes Surg. https://doi.org/10.1007/s11695-019-04014-z

    Article  PubMed  PubMed Central  Google Scholar 

  13. López-Nava G, Bautista-Castaño I, Jimenez A, De Grado T, Fernandez-Corbelle JP (2015) The primary obesity surgery endolumenal (POSE) procedure: one-year patient weight loss and safety outcomes. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2014.09.026

    Article  PubMed  Google Scholar 

  14. Abeid M, Miller KA, Kaddah T, Zaitoun N (2019) Outcome of primary obesity surgery endolumenal procedure as obesity treatment in private practice setting: an intervention study. Obes Surg 29(4):1364–1366. https://doi.org/10.1007/s11695-018-03698-z

    Article  PubMed  Google Scholar 

  15. Sullivan S, Swain JM, Woodman G et al (2017) Randomized sham-controlled trial evaluating efficacy and safety of endoscopic gastric plication for primary obesity: the ESSENTIAL trial. Obesity 25(2):294–301. https://doi.org/10.1002/oby.21702

    Article  PubMed  Google Scholar 

  16. Espinós JC, Turró R, Moragas G et al (2016) Gastrointestinal physiological changes and their relationship to weight loss following the POSE procedure. Obes Surg 26(5):1081–1089. https://doi.org/10.1007/s11695-015-1863-8

    Article  PubMed  Google Scholar 

  17. Miller K, Turró R, Greve JW, Bakker CM, Buchwald JN, Espinós JC (2017) MILEPOST multicenter randomized controlled trial: 12-month weight loss and satiety outcomes after pose SM vs. medical therapy. Obes Surg 27(2):310–322. https://doi.org/10.1007/s11695-016-2295-9

    Article  PubMed  Google Scholar 

  18. Jirapinyo P, Thompson CC (2018) Gastric plications for weight loss: distal primary obesity surgery endoluminal through a belt-and-suspenders approach. VideoGIE. https://doi.org/10.1016/j.vgie.2018.08.002

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fayad L, Adam A, Schweitzer M et al (2019) Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2018.08.030

    Article  PubMed  Google Scholar 

  20. O’Brien PE, Hindle A, Brennan L et al (2019) Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. https://doi.org/10.1007/s11695-018-3525-0

    Article  PubMed  Google Scholar 

  21. Flum DR, Belle SH, King WC et al (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454

    Article  Google Scholar 

  22. Hedjoudje A, Dayyeh BA, Cheskin LJ et al (2019) Efficacy and safety of endoscopic sleeve gastroplasty: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. https://doi.org/10.1016/J.CGH.2019.08.022

    Article  PubMed  Google Scholar 

  23. Cotton PB, Eisen GM, Aabakken L et al (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2009.10.027

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shikora SA, Bergenstal R, Bessler M et al (2009) Implantable gastric stimulation for the treatment of clinically severe obesity: results of the SHAPE trial. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2008.09.012

    Article  PubMed  Google Scholar 

  25. Gersin KS, Rothstein RI, Rosenthal RJ et al (2010) Open-label, sham-controlled trial of an endoscopic duodenojejunal bypass liner for preoperative weight loss in bariatric surgery candidates. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2009.11.051

    Article  PubMed  Google Scholar 

  26. Kotinda APST, de Moura DTH, Ribeiro IB et al (2020) Efficacy of intragastric balloons for weight loss in overweight and obese adults: a systematic review and meta-analysis of randomized controlled trials. Obes Surg. https://doi.org/10.1007/s11695-020-04558-5

    Article  PubMed  Google Scholar 

  27. Tate CM, Geliebter A (2017) Intragastric balloon treatment for obesity: review of recent studies. Adv Ther. https://doi.org/10.1007/s12325-017-0562-3

    Article  PubMed  Google Scholar 

  28. Genco A, López-Nava G, Wahlen C et al (2013) Multi-Centre European experience with intragastric balloon in overweight populations: 13 years of experience. Obes Surg. https://doi.org/10.1007/s11695-012-0829-3

    Article  PubMed  Google Scholar 

  29. Fayad L, Cheskin LJ, Adam A et al (2019) Endoscopic sleeve gastroplasty versus intragastric balloon insertion: efficacy, durability, and safety. Endoscopy. https://doi.org/10.1055/a-0852-3441

    Article  PubMed  Google Scholar 

  30. Singh S, de Moura DTH, Khan A et al (2020) Intragastric balloon versus endoscopic sleeve gastroplasty for the treatment of obesity: a systematic review and meta-analysis. Obes Surg. https://doi.org/10.1007/s11695-020-04644-8

    Article  PubMed  PubMed Central  Google Scholar 

  31. Singh S, Hourneaux de Moura DT, Khan A, Bilal M, Ryan MB, Thompson CC (2019) Safety and efficacy of endoscopic sleeve gastroplasty worldwide for treatment of obesity: a systematic review and meta-analysis. Surg Obes Relat Dis. https://doi.org/10.1016/J.SOARD.2019.11.012

    Article  PubMed  PubMed Central  Google Scholar 

  32. de Miranda Neto AA, de Moura DTH, Ribeiro IB et al (2020) Efficacy and safety of endoscopic sleeve gastroplasty at mid term in the management of overweight and obese patients: a systematic review and meta-analysis. Obes Surg. https://doi.org/10.1007/s11695-020-04449-9

    Article  PubMed  Google Scholar 

  33. Cheskin LJ, Hill C, Adam A et al (2019) Endoscopic sleeve gastroplasty versus high-intensity diet and lifestyle therapy: a case-matched study. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2019.09.029

    Article  PubMed  Google Scholar 

  34. Saumoy M, Schneider Y, Zhou XK et al (2018) A single-operator learning curve analysis for the endoscopic sleeve gastroplasty. Gastrointest Endosc 87(2):442–447. https://doi.org/10.1016/j.gie.2017.08.014

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge Anna Crawford (Librarian, West Virginia University Health Sciences Library) for conducting the literature searches.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, West Virginia University, 5th Floor Suite 5500, Morgantown, WV, 26506, USA

    Shailendra Singh & Shyam Thakkar

  2. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Ahmad Najdat Bazarbashi, Diogo Turiani Hourneaux de Moura, Pichamol Jirapinyo & Christopher C. Thompson

  3. West Virginia University Health Sciences Center Charleston Division, Charleston, WV, USA

    Ahmad Khan & Monica Chowdhry

  4. Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Mohammad Bilal

Authors
  1. Shailendra Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmad Najdat Bazarbashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmad Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Monica Chowdhry
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohammad Bilal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Diogo Turiani Hourneaux de Moura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pichamol Jirapinyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shyam Thakkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christopher C. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shailendra Singh.

Ethics declarations

Disclosures

Drs. Shailendra Singh, Ahmad Najdat Bazarbashi, Ahmad Khan, Monica Chowdhry, Mohammad Bilal, Diogo Turiani Hourneaux de Moura, and Shyam Thakkar have no conflicts of interest or financial ties to disclose. Dr. Pichamol Jirapinyo has the following disclosures: Apollo Endosurgery (research support), Endogastric Solutions (consultant), Fractyl (research support), GI Dynamics (consultant/research support). Dr. Christopher C. Thompson has the following disclosures: Apollo Endosurgery—Consultant/Research Support (Consulting fees/Institutional Research Grants), Aspire Bariatrics—Research Support (Institutional Research Grant), BlueFlame Healthcare Venture Fund—General Partner, Boston Scientific—Consultant (Consulting fees), Covidien/Medtronic—Consultant (Consulting Fees), EnVision Endoscopy (Board Member), Fractyl—Consultant/Advisory Board Member (Consulting Fees), GI Dynamics—Consultant (Consulting Fees)/Research Support (Institutional Research Grant), GI Windows—Ownership interest, Olympus/Spiration—Consultant (Consulting Fees).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 46 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, S., Bazarbashi, A.N., Khan, A. et al. Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis. Surg Endosc 36, 252–266 (2022). https://doi.org/10.1007/s00464-020-08267-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-08267-z

Keywords

Search

Navigation