糖尿病和非酒精性脂肪肝的内镜十二指肠粘膜消融技术:系统综述。

IF 12.8 Q1 MEDICINE, RESEARCH & EXPERIMENTAL
Med Pub Date : 2024-07-12 Epub Date: 2024-04-04 DOI:10.1016/j.medj.2024.03.014
Giovanni Musso, Silvia Pinach, Francesca Saba, Franco De Michieli, Maurizio Cassader, Roberto Gambino
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引用次数: 0

摘要

背景:2 型糖尿病(T2DM)的发病率正以惊人的速度增长,只有 50%的 T2DM 患者能通过药物治疗达到或维持适当的血糖控制。与药物疗法相比,代谢外科手术的疗效更佳,但对于大多数 T2DM 患者来说,这种手术并不可行。通过水热粘膜消融、电穿孔疗法再细胞化(ReCET)和光动力疗法进行十二指肠粘膜重铺(DMR)是一种新型内窥镜手术,分别使用热能、电能和光化学能消融和重置功能障碍的十二指肠粘膜。我们评估了这些技术对血糖控制和非酒精性脂肪肝(NAFLD)影响的数据:我们对截至 2024 年 1 月 31 日的英语和非英语出版物进行了独立、重复的系统检索。评估的结果是不同代谢健康参数的改善情况以及十二指肠粘膜消融术(DMA)的安全性。结果以描述性方式呈现:我们从 3 项随机试验和 6 项非对照试验(其中 7 项评估了 DMR,2 项评估了 ReCET,所有试验的偏倚风险都很低)中选出了 12 份报告,共纳入了 317 名患者。DMA 可降低 HbA1c、空腹血浆葡萄糖和肝脏脂肪。当与新型抗糖尿病药物联合使用时,多达86%的患者可以停用胰岛素。没有出现重大安全信号:所有 DMA 技术都能改善葡萄糖稳态;DMR 和 ReCET 似乎对 T2DM 患者是安全的。如果未来的随机试验和非酒精性脂肪肝的组织学终点试验证实了这一点,那么 DMA 似乎是治疗 T2DM 和非酒精性脂肪肝的药物替代或补充方案:本研究未获得任何资助。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endoscopic duodenal mucosa ablation techniques for diabetes and nonalcoholic fatty liver disease: A systematic review.

Background: Type 2 diabetes mellitus (T2DM) is increasing at an alarming rate, and only 50% of patients with T2DM achieve or maintain adequate glycemic control with pharmacological therapies. Metabolic surgery demonstrated superior efficacy compared to medical therapy but is unfeasible for most patients with T2DM. Duodenal mucosal resurfacing (DMR) by hydrothermal mucosal ablation, recellularization via electroporation therapy (ReCET), and photodynamic therapy are novel endoscopic procedures that use thermal, electrical, and photochemical energy, respectively, to ablate and reset dysfunctional duodenal mucosa. We assessed the data on the effects of these techniques on glycemic control and nonalcoholic fatty liver disease (NAFLD).

Methods: We systematically searched independently and in duplicate English and non-English language publications through January 31st, 2024. Outcomes assessed were an improvement in different metabolic health parameters and the safety of duodenal mucosal ablation (DMA) procedures. Outcomes were presented descriptively.

Findings: We selected 12 reports reporting results from 3 randomized and 6 uncontrolled trials (seven evaluating DMR, two evaluating ReCET, all with a low risk of bias) for a total of 317 patients enrolled. DMA reduced HbA1c, fasting plasma glucose, and liver fat. When combined with newer antidiabetic drugs, it allowed insulin discontinuation in up to 86% patients. No major safety signal emerged.

Conclusions: All DMA techniques improve glucose homeostasis; DMR and ReCET appear to be safe in patients with T2DM. If confirmed by future randomized trials and by trials with histological endpoints in NAFLD, then DMA appears to be a promising alternative or complement option to medications for T2DM and NAFLD treatment.

Funding: This study received no funding.

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来源期刊
Med
Med MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
17.70
自引率
0.60%
发文量
102
期刊介绍: Med is a flagship medical journal published monthly by Cell Press, the global publisher of trusted and authoritative science journals including Cell, Cancer Cell, and Cell Reports Medicine. Our mission is to advance clinical research and practice by providing a communication forum for the publication of clinical trial results, innovative observations from longitudinal cohorts, and pioneering discoveries about disease mechanisms. The journal also encourages thought-leadership discussions among biomedical researchers, physicians, and other health scientists and stakeholders. Our goal is to improve health worldwide sustainably and ethically. Med publishes rigorously vetted original research and cutting-edge review and perspective articles on critical health issues globally and regionally. Our research section covers clinical case reports, first-in-human studies, large-scale clinical trials, population-based studies, as well as translational research work with the potential to change the course of medical research and improve clinical practice.
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