BACKGROUND There is a scarcity of evidence and systematic reviews on endoscopic gastroplasty(EG)compared to other management options for the treatment of obesity.AIM To assess the published meta-analyses through a sys...BACKGROUND There is a scarcity of evidence and systematic reviews on endoscopic gastroplasty(EG)compared to other management options for the treatment of obesity.AIM To assess the published meta-analyses through a systematic review approach and provide further insight into the current status of available evidence through a critical appraisal.METHODS PubMed/MEDLINE,Scopus,Embase and Cochrane Library were searched from inception to November 2022.The meta-analyses that compared the efficacy and safety of EG to other interventions were considered for this overview.The outcomes of interest were total body weight loss(TBWL),excessive weight loss,and average weight loss along with occurrence of adverse effects.Methodological quality,heterogeneity,and limitations were also reviewed.RESULTS A total of six meta-analyses out of 364 records were considered for this review with a major contribution from the United States.Overall methodological quality of included studies were moderate to good.EG treatments were significantly better in terms of TBWL,excessive weight loss,and average weight loss.However,there was no significant difference between endoscopic transoral outlet reduction and full-thickness suturing plus argon plasma mucosal coagulation.Lack of comparative studies and randomized trials,lack of long-term follow-up,reporting bias,selection bias,lack of control groups,and considerable level of heterogeneity were the major limitations in the available evidence.CONCLUSION Though EG was significantly effective for treatment of obesity,there is limited comparative evidence on this topic.High-quality well-controlled evidence is required to strengthen the current evidence base on EG treatment for obesity.展开更多
Obesity rates have increased,and so has the need for more specific treatments.This trend has raised interest in non-surgical weight loss techniques that are novel,safe,and straightforward.Thus,the present review descr...Obesity rates have increased,and so has the need for more specific treatments.This trend has raised interest in non-surgical weight loss techniques that are novel,safe,and straightforward.Thus,the present review describes the endoscopic bariatric treatment for obesity,its most recent supporting data,the questions it raises,and its future directions.Various endoscopic bariatric therapies for weight reduction,such as intragastric balloons(IGBs),aspiration therapy(AT),small bowel endoscopy,endoscopic sleeve gastroplasty,endoluminal procedures,malabsorption endoscopic procedures,and methods of regulating gastric emptying,were explored through literature sourced from different databases.IGBs,AT,and small bowel endoscopy have short-term effects with a possibility of weight regain.Minor adverse events have occurred;however,all procedures reduce weight.Vomiting and nausea are common side effects,although serious complications have also been observed.展开更多
BACKGROUND Direct acting antivirals(DAAs)are a very effective treatment for hepatitis C virus(HCV).However,brand DAAs are expensive.The licensing of cheaper generic DAAs may address this issue,but there is a lack of c...BACKGROUND Direct acting antivirals(DAAs)are a very effective treatment for hepatitis C virus(HCV).However,brand DAAs are expensive.The licensing of cheaper generic DAAs may address this issue,but there is a lack of clinical studies comparing the efficacy of generic vs brand DAA formulations.AIM To compare the efficacy and safety of generic against brand DAAs for chronic hepatitis C treatment in Bahrain.METHODS This was a retrospective observational study involving 289 patients with chronic HCV infection during 2016 to 2018.There were 149 patients who were treated with brand DAAs,while 140 patients were treated with generic DAAs.Commonly used DAAs were Ombitasvir/Paritaprevir/Ritonavir±Dasabuvir±Ribavirin,and Sofosbuvir/Daclatasvir±Ribavirin.SVR at 12 wk post treatment was the main outcome variable.RESULTS Overall,87 patients(30.1%)had cirrhosis and 68.2%had genotype 1 HCV infection.At 12 wk post treatment,SVR was achieved by 271(93.8%)of the patients.In patients who were treated with generic medications,134(95.7%)achieved SVR at 12 wk post treatment,compared to 137(91.9%)among those treated with brand medications(P=0.19).Having cirrhosis[odds ratio(OR):9.41,95%confidence interval(CI):2.47–35.84]and having HCV genotype 3(OR:3.56,95%CI:1.03–12.38)were significant independent predictors of not achieving SVR.Alanine transaminase,gamma-glutamyl transpeptidase,and total bilirubin levels decreased significantly following therapy with both generic and brand DAAs.CONCLUSION Generic and brand DAAs demonstrate comparable effectiveness in the treatment of chronic hepatitis C patients.Both are safe and equally effective in improving biochemical markers of hepatic inflammation.展开更多
文摘BACKGROUND There is a scarcity of evidence and systematic reviews on endoscopic gastroplasty(EG)compared to other management options for the treatment of obesity.AIM To assess the published meta-analyses through a systematic review approach and provide further insight into the current status of available evidence through a critical appraisal.METHODS PubMed/MEDLINE,Scopus,Embase and Cochrane Library were searched from inception to November 2022.The meta-analyses that compared the efficacy and safety of EG to other interventions were considered for this overview.The outcomes of interest were total body weight loss(TBWL),excessive weight loss,and average weight loss along with occurrence of adverse effects.Methodological quality,heterogeneity,and limitations were also reviewed.RESULTS A total of six meta-analyses out of 364 records were considered for this review with a major contribution from the United States.Overall methodological quality of included studies were moderate to good.EG treatments were significantly better in terms of TBWL,excessive weight loss,and average weight loss.However,there was no significant difference between endoscopic transoral outlet reduction and full-thickness suturing plus argon plasma mucosal coagulation.Lack of comparative studies and randomized trials,lack of long-term follow-up,reporting bias,selection bias,lack of control groups,and considerable level of heterogeneity were the major limitations in the available evidence.CONCLUSION Though EG was significantly effective for treatment of obesity,there is limited comparative evidence on this topic.High-quality well-controlled evidence is required to strengthen the current evidence base on EG treatment for obesity.
文摘Obesity rates have increased,and so has the need for more specific treatments.This trend has raised interest in non-surgical weight loss techniques that are novel,safe,and straightforward.Thus,the present review describes the endoscopic bariatric treatment for obesity,its most recent supporting data,the questions it raises,and its future directions.Various endoscopic bariatric therapies for weight reduction,such as intragastric balloons(IGBs),aspiration therapy(AT),small bowel endoscopy,endoscopic sleeve gastroplasty,endoluminal procedures,malabsorption endoscopic procedures,and methods of regulating gastric emptying,were explored through literature sourced from different databases.IGBs,AT,and small bowel endoscopy have short-term effects with a possibility of weight regain.Minor adverse events have occurred;however,all procedures reduce weight.Vomiting and nausea are common side effects,although serious complications have also been observed.
文摘BACKGROUND Direct acting antivirals(DAAs)are a very effective treatment for hepatitis C virus(HCV).However,brand DAAs are expensive.The licensing of cheaper generic DAAs may address this issue,but there is a lack of clinical studies comparing the efficacy of generic vs brand DAA formulations.AIM To compare the efficacy and safety of generic against brand DAAs for chronic hepatitis C treatment in Bahrain.METHODS This was a retrospective observational study involving 289 patients with chronic HCV infection during 2016 to 2018.There were 149 patients who were treated with brand DAAs,while 140 patients were treated with generic DAAs.Commonly used DAAs were Ombitasvir/Paritaprevir/Ritonavir±Dasabuvir±Ribavirin,and Sofosbuvir/Daclatasvir±Ribavirin.SVR at 12 wk post treatment was the main outcome variable.RESULTS Overall,87 patients(30.1%)had cirrhosis and 68.2%had genotype 1 HCV infection.At 12 wk post treatment,SVR was achieved by 271(93.8%)of the patients.In patients who were treated with generic medications,134(95.7%)achieved SVR at 12 wk post treatment,compared to 137(91.9%)among those treated with brand medications(P=0.19).Having cirrhosis[odds ratio(OR):9.41,95%confidence interval(CI):2.47–35.84]and having HCV genotype 3(OR:3.56,95%CI:1.03–12.38)were significant independent predictors of not achieving SVR.Alanine transaminase,gamma-glutamyl transpeptidase,and total bilirubin levels decreased significantly following therapy with both generic and brand DAAs.CONCLUSION Generic and brand DAAs demonstrate comparable effectiveness in the treatment of chronic hepatitis C patients.Both are safe and equally effective in improving biochemical markers of hepatic inflammation.
