内镜夹联合尼龙圈实施内镜下胃径向压缩术在减重治疗的有效性及安全性评估（含视频）

Efficacy and safety of endoscopic radial compression gastroplasty using clips and endoloops for weight reduction (with video)

摘要:

目的 评估内镜夹联合尼龙圈完成内镜下胃径向压缩术（endoscopic radial compression gastroplasty，ERCG）的有效性与安全性。方法 采用前瞻性队列研究设计，纳入2024年7月至2025年7月中国人民解放军总医院第五医学中心收治的超重或轻中度肥胖患者（体重指数24.0~37.4 kg/m²，18~65岁），接受ERCG治疗并完成3个月随访。术前进行一般情况、实验室及影像学评估，手术通过内镜夹固定尼龙圈于胃壁完成3~5次缝合，观察术后3个月多余体重减少百分比（percentage of excess weight loss，%EWL）、总体重减少百分比（percentage of total weight loss，%TWL）及代谢指标改善情况。结果 纳入20例患者，均顺利完成手术及随访。手术时长（27.4±3.8）min，使用尼龙圈（3.7±0.5）个、内镜夹（12.9±2.7）个。术后3个月，患者体重由（101.2±11.4）kg降至（89.2±10.3）kg（t=5.827，P<0.001），体重指数由（31.4±3.7）kg/m²降至（27.7±3.7）kg/m²（t=6.257，P<0.001），%EWL为（57.2±34.8）%，%TWL为（12.3±8.2）%。代谢改善方面，脂肪肝患者肝脏受控衰减参数由（321.7±62.1）dB/m降至（278.7±50.8）dB/m（t=7.629，P<0.001），总胆固醇由（4.4±0.5）mmol/L降至（3.9±0.8）mmol/L（t=3.093，P=0.006）、甘油三酯由（1.6±0.8）mmol/L降至（1.5±0.7）mmol/L（t=2.102，P=0.049），糖化血红蛋白由（7.1±1.5）%降至（6.7±0.9）%（t=2.448，P=0.024），空腹胰岛素由（15.0±2.7）mU/L降至（13.4±1.8）mU/L（t=2.632，P=0.019），空腹血糖由（5.9±1.8）mmol/L降至（5.5±1.2）mmol/L，但差异无统计学意义（t=0.832，P=0.417）。安全性上，术后即刻不良事件以轻中度中上腹痛为主，疼痛视觉模拟评分（2.9±1.6）分，2例出现反流性食管炎（2/20，95%CI：2.8%~30.1%），无严重并发症及死亡病例。结论 ERCG操作简便、安全性高，能有效减少超重及肥胖患者体重，改善脂肪肝及血脂等代谢指标，为超重与肥胖人群提供了安全可行的微创减重新选择。

Abstract:

Objective To evaluate the efficacy and safety of endoscopic radial compression gastroplasty (ERCG) using clips combined with endoloops. Methods This prospective cohort study enrolled overweight or mild to moderate obese patients with body mass index (BMI) 24.0-37.4 kg/m², aged 18-65 years, treated at the Fifth Medical Center of Chinese PLA General Hospital between July 2024 and July 2025. All patients underwent ERCG and completed a 3-month follow-up. Baseline demographic, laboratory, and imaging evaluations were performed before treatment. During the procedure, endoloops were secured to the gastric wall using endoscopic clips to create 3-5 radial plications. At 3 months post-procedure, changes in percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), and metabolic indicators were assessed. Results All 20 patients successfully completed the procedure. The operative time was 27.4±3.8 min, with 3.7±0.5 endoloops and 12.9±2.7 clips used. At 3 months, body weight decreased from 101.2±11.4 kg to 89.2±10.3 kg (t=5.827, P<0.001), and BMI declined from 31.4±3.7 kg/m2 to 27.7±3.7 kg/m² (t=6.257, P<0.001). The %EWL was 57.2%±34.8%, and %TWL was 12.3%±8.2%. The controlled attenuation parameter (CAP) in patients with fatty liver decreased from 321.7±62.1 dB/m to 278.7±50.8 dB/m (t=7.629, P<0.001). Total cholesterol decreased from 4.4±0.5 mmol/L to 3.9±0.8 mmol/L (t=3.093, P=0.006), and triglycerides decreased from 1.6±0.8 mmol/L to 1.5±0.7 mmol/L (t=2.102, P=0.049). Glycated hemoglobin decreased from 7.1%±1.5% to 6.7%±0.9% (t=2.448, P=0.024), fasting insulin decreased significantly (15.0±2.7 mU/L VS 13.4±1.8 mU/L, t=2.632, P=0.019), whereas fasting blood glucose showed downward trends without statistically significant differences (5.9±1.8 mmol/L VS 5.5±1.2 mmol/L, t=0.832, P=0.417). Regarding safety, immediate postoperative adverse events were mainly mild-to-moderate upper abdominal pain, with a visual analogue scale score of 2.9±1.6. Two patients developed mild reflux esophagitis (2/20, 95%CI: 2.8%-30.1%). No severe complications or mortality occurred. Conclusion ERCG is a simple, safe and effective endoscopic technique for reducing body weight and improving metabolic parameters such as hepatic steatosis and dyslipidemia in overweight and obese patients. It provides a feasible, minimally invasive option for weight management.