外科理论与实践 ›› 2025, Vol. 30 ›› Issue (05): 392-399.doi: 10.16139/j.1007-9610.2025.05.04
收稿日期:2025-07-27
出版日期:2025-09-25
发布日期:2025-12-09
通讯作者:
薛育政,E-mail: yuzhengxue_ahjnu@126.com
SUN Haowen, YIN Yuzhe, WANG Yiting, XUE Yuzheng(
)
Received:2025-07-27
Online:2025-09-25
Published:2025-12-09
摘要:
肥胖已成为全球性公共健康挑战,其相关并发症显著增加。传统外科减重手术疗效确切,但创伤大、风险高,解剖改变不可逆,限制其广泛应用。随着消化内镜技术的快速发展,内镜减重治疗逐渐成为一种兼具安全性和有效性的微创替代方案。本文介绍多种内镜减重技术的研究进展与临床应用,包括通过占位效应减少胃容量的胃内球囊置入术、内镜胃袖状成形术和腔内减重手术,以及经口装置实现的缝合与吻合技术。还介绍以清除胃内容物为核心的吸引疗法,以及模拟外科旁路和黏膜重建的十二指肠-空肠旁路套管和十二指肠黏膜消融等新兴方法。内镜减重技术已展现出广阔的应用前景,有望成为肥胖综合治疗体系中的重要组成部分。
中图分类号:
孙浩文, 尹钰哲, 王怡婷, 薛育政. 不同内镜减重技术在治疗肥胖症中的优势与存在的问题——《中国肥胖症消化内镜治疗专家共识》解读[J]. 外科理论与实践, 2025, 30(05): 392-399.
SUN Haowen, YIN Yuzhe, WANG Yiting, XUE Yuzheng. Advantages and challenges of different endoscopic bariatric technologies in the treatment of obesity — interpretation of Expert consensus on digestive endoscopic treatment for obesity in China[J]. Journal of Surgery Concepts & Practice, 2025, 30(05): 392-399.
| [1] |
CHANG CHUSAN Y A, ENELI I, HENNESSY E, et al. Next steps in efforts to address the obesity epidemic[J]. Annu Rev Public Health, 2025, 46(1):171-191.
doi: 10.1146/annurev-publhealth-060922-044108 URL |
| [2] |
苏淼, 王飒爽, 赵东强. 《中国肥胖症消化内镜治疗专家共识》解读[J]. 临床荟萃, 2025, 40(4):366-371.
doi: 10.3969/j.issn.1004-583X.2025.04.013 |
|
SU M, WANG S S, ZHAO D Q. Interpretation of the Chinese expert consensus on gastrointestinal endoscopic treatment of obesity[J]. Clin Focus, 2025, 40(4):366-371.
doi: 10.3969/j.issn.1004-583X.2025.04.013 |
|
| [3] | 中华医学会消化内镜学分会微创减重治疗协作组, 中国医师协会消化医师分会减重专业委员会, 国家消化系统疾病临床医学研究中心(北京). 中国肥胖症消化内镜治疗专家共识[J]. 中华消化内镜杂志, 2024, 41(1):1-10. |
| Chinese Society of Gastrointestinal Endoscopy Minimally Invasive Weight Loss Treatment Collaborative Group, Chinese Medical Doctor Association Gastroenterology Branch Weight Loss Committee, National Clinical Research Center for Digestive Diseases (Beijing). Expert consensus on digestive endoscopic treatment for obesity in China[J]. Chin J Dig Endosc, 2024, 41(1):1-10. | |
| [4] |
GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the global burden of disease study 2021[J]. Lancet, 2025, 405(10481):813-838.
doi: 10.1016/S0140-6736(25)00355-1 pmid: 40049186 |
| [5] | 中国居民营养与慢性病状况报告(2020年)[J]. 营养学报, 2020, 42(6):521. |
| Report on the status of nutrition and chronic diseases among Chinese residents (2020)[J]. Acta Nutrimenta Sinica, 2020, 42(6):521. | |
| [6] | 李梦伊, 刘雁军, 王桂琦, 等. 大中华减重与代谢手术数据库2023年度报告[J]. 中国实用外科杂志, 2024, 44(5):552-563,570. |
| LI M Y, LIU Y J, WANG G Q, et al. Greater China metabolic and bariatric surgery database registry report(2023)[J]. Chin J Pract Surg, 2024, 44(5):552-563,570. | |
| [7] |
ALSAQAABY M S, COONEY S, LE ROUX C W, et al. Sex, race, and BMI in clinical trials of medications for obesity over the past three decades: a systematic review[J]. Lancet Diabetes Endocrinol, 2024, 12(6):414-421.
doi: 10.1016/S2213-8587(24)00098-6 URL |
| [8] | YUAN C, DONG Y, CHEN H, et al. Determinants of childhood obesity in China[J]. Lancet Public Health, 2024, 9(12):e1105-e1114. |
| [9] | WEI Y, LI P, ZHANG S. From surgery to endoscopy: the evolution of the bariatric discipline[J]. Chin Med J (Engl), 2022, 135(20):2427-2435. |
| [10] |
LAING P, PHAM T, TAYLOR L J, et al. Filling the void: a review of intragastric balloons for obesity[J]. Dig Dis Sci, 2017, 62(6):1399-1408.
doi: 10.1007/s10620-017-4566-2 URL |
| [11] |
COURCOULAS A, ABU DAYYEH B K, EATON L, et al. Intragastric balloon as an adjunct to lifestyle intervention: a randomized controlled trial[J]. Int J Obes (Lond), 2017, 41(3):427-433.
doi: 10.1038/ijo.2016.229 |
| [12] |
ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee, Abu Dayyeh B K, Kumar N, et al. ASGE bariatric endoscopy task force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies[J]. Gastrointest Endosc, 2015, 82(3):425-438.e5.
doi: 10.1016/j.gie.2015.03.1964 pmid: 26232362 |
| [13] | TRANG J, LEE S S, MILLER A, et al. Incidence of nausea and vomiting after intragastric balloon placement in bariatric patients - a systematic review and meta-analysis[J]. Int J Surg, 2018,57:22-29. |
| [14] |
MACHYTKA E, KLVANA P, KORNBLUTH A, et al. Adjustable intragastric balloons: a 12-month pilot trial in endoscopic weight loss management[J]. Obes Surg, 2011, 21(10):1499-1507.
doi: 10.1007/s11695-011-0424-z pmid: 21553304 |
| [15] |
MACHYTKA E, GAUR S, CHUTTANI R, et al. Elipse, the first procedureless gastric balloon for weight loss: a prospective, observational, open-label, multicenter study[J]. Endoscopy, 2016, 49(2):154-160.
doi: 10.1055/s-0042-119296 URL |
| [16] |
IENCA R, AL JARALLAH M, CABALLERO A, et al. The procedureless elipse gastric balloon program: multicenter experience in 1770 consecutive patients[J]. Obes Surg, 2020, 30(9):3354-3362.
doi: 10.1007/s11695-020-04539-8 pmid: 32279182 |
| [17] |
MARINOS G, ELIADES C, RAMAN MUTHUSAMY V, et al. Weight loss and improved quality of life with a nonsurgical endoscopic treatment for obesity: clinical results from a 3- and 6-month study[J]. Surg Obes Relat Dis, 2014, 10(5):929-934.
doi: 10.1016/j.soard.2014.03.005 pmid: 25066439 |
| [18] |
ABU DAYYEH B K, BAZERBACHI F, VARGAS E J, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial[J]. Lancet, 2022, 400(10350):441-451.
doi: 10.1016/S0140-6736(22)01280-6 pmid: 35908555 |
| [19] |
BADURDEEN D, HOFF A C, HEDJOUDJE A, et al. Endoscopic sleeve gastroplasty plus liraglutide versus endoscopic sleeve gastroplasty alone for weight loss[J]. Gastrointest Endosc, 2021, 93(6):1316-1324.e1.
doi: 10.1016/j.gie.2020.10.016 URL |
| [20] |
LI P, MA B, GONG S, et al. Efficacy and safety of endoscopic sleeve gastroplasty for obesity patients: a meta-analysis[J]. Surg Endosc, 2020, 34(3):1253-1260.
doi: 10.1007/s00464-019-06889-6 pmid: 31236722 |
| [21] |
HEDJOUDJE A, ABU DAYYEH B K, CHESKIN L J, et al. Efficacy and safety of endoscopic sleeve gastroplasty: a systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol, 2020, 18(5):1043-1053.e4.
doi: 10.1016/j.cgh.2019.08.022 URL |
| [22] |
VARGAS E J, RIZK M, GOMEZ-VILLA J, et al. Effect of endoscopic sleeve gastroplasty on gastric emptying, moti-lity, and hormones: a comparative prospective study[J]. Gut, 2023, 72(6):1073-1080.
doi: 10.1136/gutjnl-2022-327816 URL |
| [23] |
SHARAIHA R Z, HAJIFATHALIAN K, KUMAR R, et al. Five-year outcomes of endoscopic sleeve gastroplasty for the treatment of obesity[J]. Clin Gastroenterol Hepatol, 2021, 19(5):1051-1057.e2.
doi: 10.1016/j.cgh.2020.09.055 URL |
| [24] |
JIRAPINYO P, ADVANI R, AL-SABBAN A, et al. Establishing standards of practice for endoscopic sleeve gastroplasty: a global expert consensus using a modified Delphi method[J]. Gastrointest Endosc, 2025, 102(2):285-289.
doi: 10.1016/j.gie.2025.03.642 URL |
| [25] |
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[J]. Surg Endosc, 2022, 36(1):252-266.
doi: 10.1007/s00464-020-08267-z |
| [26] | LOPEZ-NAVA G, ASOKKUMAR R, TURRÓ ARAU R, et al. Modified primary obesity surgery endoluminal (POSE-2) procedure for the treatment of obesity[J]. Video-GIE, 2020, 5(3):91-93. |
| [27] |
MATTEO M V, PONTECORVI V, BOVE V, et al. Prospective, single-arm multicenter, international, observational postmarket study to assess the safety and efficacy of a triangulation platform for treating patients requiring endoscopic gastroplasty[J]. Gastrointest Endosc, 2025, 101(1):106-116.e1.
doi: 10.1016/j.gie.2024.06.041 URL |
| [28] |
STIER C, BALONOV I, STIER R, et al. Endoscopic management of clinically severe obesity: primary and secondary therapeutic procedures[J]. Curr Obes Rep, 2020, 9(3):339-347.
doi: 10.1007/s13679-020-00385-y pmid: 32495297 |
| [29] |
JIRAPINYO P, THOMPSON C C. Comparison of distal primary obesity surgery endolumenal techniques for the treatment of obesity (with videos)[J]. Gastrointest Endosc, 2022, 96(3):479-486.
doi: 10.1016/j.gie.2022.04.1346 URL |
| [30] |
MRAD R, AL ANNAN K, SAYEGH L, et al. Comparative effectiveness of balloons, adjustable balloons, and endoscopic sleeve gastroplasty: a network meta-analysis of randomized trials[J]. Gastrointest Endosc, 2025, 101(3):527.e1-527.e9.
doi: 10.1016/j.gie.2024.05.017 URL |
| [31] |
LOPEZ NAVA G, ARAU R T, ASOKKUMAR R, et al. Prospective multicenter study of the primary obesity surgery endoluminal (POSE 2.0) procedure for treatment of obesity[J]. Clin Gastroenterol Hepatol, 2023, 21(1):81-89.e4.
doi: 10.1016/j.cgh.2022.04.019 URL |
| [32] |
FAMILIARI P, COSTAMAGNA G, BLÉRO D, et al. Transoral gastroplasty for morbid obesity: a multicenter trial with a 1-year outcome[J]. Gastrointest Endosc, 2011, 74(6):1248-1258.
doi: 10.1016/j.gie.2011.08.046 pmid: 22136774 |
| [33] |
VERLAAN T, PAULUS G F, MATHUS-VLIEGEN E M H, et al. Endoscopic gastric volume reduction with a novel articulating plication device is safe and effective in the treatment of obesity (with video)[J]. Gastrointest Endosc, 2015, 81(2):312-320.
doi: 10.1016/j.gie.2014.06.017 pmid: 25085333 |
| [34] |
MCCARTY T R, THOMPSON C C. The current state of bariatric endoscopy[J]. Dig Endosc, 2021, 33(3):321-334.
doi: 10.1111/den.v33.3 URL |
| [35] |
BOSKOSKI I, LOPEZ-NAVA G, RAVISHANKAR A, et al. Automatic endoscopic gastroplasty for the treatment of obesity: results from a prospective multicenter study (with video)[J]. Gastrointest Endosc, 2025, 101(4):818-827.
doi: 10.1016/j.gie.2024.09.026 URL |
| [36] |
HAJIFATHALIAN K, SIMMONS O, ABU-HAMMOUR M, et al. Efficacy of endoscopic resuturing versus pharmacotherapy to treat weight recidivism after endoscopic sleeve gastroplasty[J]. Gastrointest Endosc, 2023, 98(6):944-949.
doi: 10.1016/j.gie.2023.07.018 URL |
| [37] |
LAHOOTI A, WESTERVELD D, JOHNSON K, et al. Improvement in obesity-related comorbidities 5 years after endoscopic sleeve gastroplasty: a prospective cohort study[J]. Gastrointest Endosc, 2025, 102(1):26-36.
doi: 10.1016/j.gie.2024.12.017 URL |
| [38] |
NYSTRÖM M, MACHYTKA E, NORÉN E, et al. Aspiration therapy as a tool to treat obesity: 1- to 4-year results in a 201-patient multi-center post-market european registry study[J]. Obes Surg, 2018, 28(7):1860-1868.
doi: 10.1007/s11695-017-3096-5 pmid: 29388050 |
| [39] |
THOMPSON C C, ABU DAYYEH B K, KUSHNIR V, et al. Aspiration therapy for the treatment of obesity: 4-year results of a multicenter randomized controlled trial[J]. Surg Obes Relat Dis, 2019, 15(8):1348-1354.
doi: S1550-7289(18)31266-8 pmid: 31302000 |
| [40] |
SULLIVAN S, STEIN R, JONNALAGADDA S, et al. Aspiration therapy leads to weight loss in obese subjects: a pilot study[J]. Gastroenterology, 2013, 145(6):1245-1252.e1-e5.
doi: 10.1053/j.gastro.2013.08.056 pmid: 24012983 |
| [41] |
MCLENNAN S, VERHOEFF K, PURICH K, et al. Duodenal-jejunal bypass liners are superior to optimal medical management in ameliorating metabolic dysfunction: a systematic review and meta-analysis[J]. Obes Rev, 2023, 24(8):e13572.
doi: 10.1111/obr.v24.8 URL |
| [42] |
EGAN A M, VELLA A. Endoscopic treatments for obesity: the good, the bad, and the ugly[J]. Endocrinol Metab Clin North Am, 2020, 49(2):315-328.
doi: 10.1016/j.ecl.2020.02.001 URL |
| [43] |
CHEN W, FENG J, DONG S, et al. Efficacy and safety of duodenal-jejunal bypass liner for obesity and type 2 diabetes: a systematic review and meta-analysis[J]. Obes Rev, 2024, 25(11):e13812.
doi: 10.1111/obr.v25.11 URL |
| [44] |
HOYT J A, COZZI E, D'ALESSIO D A, et al. A look at duodenal mucosal resurfacing: rationale for targeting the duodenum in type 2 diabetes[J]. Diabetes Obes Metab, 2024, 26(6):2017-2028.
doi: 10.1111/dom.15533 pmid: 38433708 |
| [45] | MUSSO G, PINACH S, SABA F, et al. Endoscopic duodenal mucosa ablation techniques for diabetes and nonalcoholic fatty liver disease: a systematic review[J]. Med (New York, NY), 2024, 5(7):735-758.e2. |
| [46] |
MEIRING S, BUSCH C B E, VAN BAAR A C G, et al. Eliminating exogenous insulin therapy in patients with type 2 diabetes by duodenal ablation and GLP-1RA decreases risk scores for cardiovascular events[J]. Cardiovasc Diabetol, 2022, 21(1):191.
doi: 10.1186/s12933-022-01628-z pmid: 36138441 |
| [47] |
PARK C S, PARK H J, PARK J H, et al. Highly functional duodenal stent with photosensitizers enables photodynamic therapy for metabolic syndrome treatment: feasibility and safety study in a porcine model[J]. APL Bioeng, 2024, 8(3):036103.
doi: 10.1063/5.0206328 URL |
| [48] |
JANG S I, DO M Y, LEE S Y, et al. Magnetic compression anastomosis for the treatment of complete biliary obstruction after cholecystectomy[J]. Gastrointest Endosc, 2024, 100(6):1053-1060.e4.
doi: 10.1016/j.gie.2024.05.009 URL |
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Check韧带悬吊术治疗重度先天性上睑下垂
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经口单通道内镜下齿状突切除:病例报道1例
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