Endoscopic sleeve gastroplasty — minimally invasive treatment for non-alcoholic fatty liver disease and obesity

Abstract

Introduction Adequate weight loss can lead to reduction in steatosis, inflammation, and fibrosis in patients with obesity and nonalcoholic fatty liver disease (NAFLD). We evaluated the role of endoscopic sleeve gastroplasty (ESG) in patients with obesity and NAFLD. Methods In this single-center prospective study, consecutive adult patients with NAFLD who underwent ESG between November 2018 and May 2019 were included. The primary outcome was the impact of ESG on hepatic parameters: change in alanine aminotransferase (ALT), hepatic steatosis index (HSI), NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4), and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) from baseline to 6 and 12 months. Secondary outcomes included change in glycated hemoglobin (HbA1c), percentage weight loss, and safety. Analysis of variance with repeated measures was used for statistical analysis. Results A total of 26 patients (mean age [SD] 41.5 [9.58] years; 16 females) with mean (SD) weight of 99.43 (21.89) kg at baseline were included. There was significant improvement in ALT (mean ± SD) from baseline of 59.54 ± 17.02 IU/L to 49.50 ± 11.72 IU/L and 48.42 ± 13.22 IU/L at 6 and 12 months (p = 0.001). Mean (SD) NFS was significantly improved from 0.228 (1.00) at baseline to −0.202 (1.16) and −0.552 (1.08) at 6 and 12 months (p 0.001). Mean (SD) HSI, FIB-4, and APRI scores significantly reduced from baseline to 6 and 12 months (p = 0.001). There was 18.07% total body weight loss at 12 months, with significant improvement in HbA1c. There were no major adverse events. Conclusion ESG is a safe and effective treatment option for patients with NAFLD and obesity causing significant weight loss. Rigorous randomized trials are required to incorporate ESG in NAFLD treatment algorithm.

Endoscopic Bariatric and Metabolic Therapies and Their Effects on Metabolic Syndrome and Non-alcoholic Fatty Liver Disease - A Systematic Review and Meta-Analysis

“…A prospective study conducted by Bazerbachi et al ( 48 ) analyzed the impact of IGB on metabolic and histologic improvements in nonalcoholic steatohepatitis (NASH) and found that the nonalcoholic fatty liver disease activity score (NAS) improved in 90% of the patients, with a median decrease of three points. Similarly, prospective studies conducted by Jagtap et al ( 49 ), Hajifathalian et al ( 50 ), Rosenblatt et al ( 51 ) showed that ESG had significant improvement in ALT, NAFLD fibrosis and FIB-4 score and hepatic steatosis index (HSI). There are only two studies in our systematic review that looked at the impact of DMR on liver biochemistry by Mingrone et al ( 43 ) and Kaur et al ( 44 ), and both concluded that DMR has no significant difference in the liver profile.…”

Future of Metabolic Endoscopy

“…Another prospective study assessed the impact of ESG on liver parameters, steatosis, and fibrosis in NAFLD patients and reported significant improvement in ALT, hepatic steatosis index, NAFLD fibrosis score, Fibrosis-4 (FIB-4), and AST to platelet ratio index (APRI) scores at both 6 and 12 months. 32 Additionally, the %TBWL was 18% at 12 months with no observed AEs.…”

Novel Endoscopic Bariatric Therapies for the Management of Nonalcoholic Steatohepatitis

“…42 In another single-center prospective study in India, 26 patients were studied post-ESG and found to have significant improvement in transaminases and multiple noninvasive scores for detection of fibrosis in patients with NAFLD (NAFLD fibrosis score, FIB-4 score, and AST [aspartate transaminase] to platelet ratio index) at 6 and 12 months. 43 A larger cohort of 118 patients with obesity and NAFLD were studied post-ESG by Hajifathalian et al 44 They found improvements in patient's HOMA-IR score (which lasted for 2 years postprocedure), hepatic steatosis index score, and NAS score. Notably, 20% of the patients had an improvement in fibrosis from F3-F4 or indeterminate to F0-F2, whereas only 1 patient (1%) experienced an increase in the estimated risk of fibrosis.…”

“…dysfunction and liver steatosis after ESG[42]. In another single center prospective study in India, 26 patients were studied post ESG and found to have significant improvement in transaminases and multiple noninvasive scores for detection of fibrosis in patients with NAFLD (NAFLD fibrosis score, FIB-4 score and AST to Platelet Ratio Index (APRI)) at 6 and 12 months[43]. A larger cohort of 118 patients with obesity and NAFLD were studied post ESG by Hajifathalian et al They found improvements in patient's HOMA-IR score (which lasted for 2 years post-procedure), hepatic steatosis index score and NAS score.…”