Supplementary Material for: Vacuum Therapy and Internal Drainage as the First-Line Endoscopic Treatment for Post-Bariatric Leaks: A Systematic Review and Meta-Analysis

Introduction: Several endoscopic methods can be employed to manage post-bariatric leaks. However, endoluminal vacuum therapy (EVT) and endoscopic internal drainage (EID) are relatively new methods, and studies regarding these methods are scarce. We performed a systematic review of the literature and a meta-analysis to evaluate the efficacy of EVT and EID. Methods: Databases were searched for eligible studies. The clinical success of leak closure was the primary outcome of interest. A proportional meta-analysis was performed for pooling the primary outcome using a fixed-effects model. A meta-analysis or descriptive analysis of other outcomes was performed based on the data availability. Results: Data from 3 EVT and 10 EID studies (n = 279) were used for evidence synthesis. The leak closure rates (95% confidence interval [CI]) of EVT and EID were 85.2% (75.1%–95.4%) and 91.6% (88.1%–95.2%), respectively. The corresponding mean treatment durations (95% CI) were 28 (2.4–53.6) and 78.4 (50.1–106.7) days, respectively. However, data about other outcomes were extremely limited; thus, a pooled analysis could not be performed. Conclusions: Both EVT and EID were effective when used as the first-line treatment for post-bariatric leaks. However, larger studies must be conducted to compare the efficacy of the 2 interventions.

引言：目前已有多种内镜手段可用于治疗减重术后吻合口漏。然而，腔内负压治疗（endoluminal vacuum therapy, EVT）与内镜下内引流术（endoscopic internal drainage, EID）属于相对新兴的治疗方式，相关研究较为匮乏。本研究针对这两种术式开展系统综述与荟萃分析，以评估EVT与EID的临床疗效。方法：通过检索数据库筛选符合纳入标准的研究。本研究的主要结局指标为吻合口漏闭合的临床成功率。采用固定效应模型对主要结局指标进行比例型荟萃分析以合并效应量；其余结局指标则根据数据可得性，分别开展荟萃分析或描述性分析。结果：最终纳入3项EVT相关研究与10项EID相关研究，共涉及279例患者。EVT与EID的吻合口漏闭合率（95%置信区间[CI]）分别为85.2%（75.1%~95.4%）与91.6%（88.1%~95.2%）；对应的平均治疗时长（95%置信区间[CI]）分别为28（2.4~53.6）天与78.4（50.1~106.7）天。但其余结局指标的数据极为有限，无法开展合并分析。结论：EVT与EID作为减重术后吻合口漏的一线治疗手段均具备有效性。但未来仍需开展大样本研究，以对比两种干预措施的疗效差异。