Outcomes following Serial Intragastric Balloon Therapy for Obesity and Nonalcoholic Fatty Liver Disease in a Single Centre

Abstract

Background The incidence of nonalcoholic fatty liver disease (NAFLD) continues to parallel the rise in obesity rates. Endobariatric devices such as the intragastric balloon (IGB) may provide an alternative treatment option. Methods Outcomes following IGB treatment in 135 patients with obesity and NAFLD (mean baseline weight 117.9 kg; BMI 41.7 kg/m2; HOMA-IR 3.6) were retrospectively examined. Clinical, anthropometric, and biochemical changes were analysed at six months and after consecutive treatment with two and three serial IGBs. Results After six months, significant changes were seen with weight and BMI (mean reductions of 11.3 kg and 4.1 kg/m2, resp., p < 0.01 for both). Significant improvements were also seen with ALT, GGT, and HOMA-IR, with all changes corresponding with weight loss. Forty-eight patients received two IGBs, and 20 were treated with three serial IGBs. The greatest amount of total weight loss was observed after the first 6 months (mean weight lost 7.4 kg, versus 3.6 kg and 1.9 kg with two and three IGBs, resp.). Conclusions IGB therapy is an effective, alternative nonsurgical means for weight loss in the management of obesity and NAFLD over the short term, with greatest outcomes observed after six months. Improvements in insulin resistance and hepatic transaminases correlated with weight change.

MANAGEMENT OF ENDOCRINE DISEASE: Non-alcoholic fatty liver disease: a multidisciplinary approach towards a cardiometabolic liver disease

“…But also other endobariatric procedures like space-occupying devices, aspiration therapy and endoscopic small bowel bypass therapies have been proven to be successful in inducing weight loss (89,90). A single-centre retrospective cohort study following 135 patients with obesity and NAFLD undergoing intragastric balloon (IGB) treatment revealed changes in BMI after 6 months, as well as corresponding improvement of ALT, GGT and insulin resistance (HOMA-IR) scores (91). However, as endobariatric interventions are often temporary or less durable than bariatric surgery, aggressive weight maintenance afterwards is key for lasting weight reduction.…”

Endoscopic bariatric and metabolic therapies for non‐alcoholic fatty liver disease: Evidence and perspectives

“…The main features of the studies of IGBs in NAFLD patients are shown in Table 2. Most of them assessed non‐invasive parameters of NAFLD such as liver steatosis measure by CT‐scan, 17 ultrasonography 18 or magnetic resonance imaging 19,20 . So far, only the small RCT by Lee et al have assessed changes in liver histology and showed a significant reduction of the NAFLD activity score after 6 months from Orbera™ placement 21 .…”

Endoscopic bariatric and metabolic therapies for non-alcoholic fatty liver disease

“…Gastric EBMTs have shown weight loss dependent improvement in histologic and biochemical parameters of NAFLD. [7][8][9][10] The proximal small intestine plays a central role in the pathogenesis of type II diabetes and NAFLD orchestrated through a variety of pathways, resulting in insulin resistance and chronic inflammation. These pathways include alteration of gut incretin to anti-incretin neurohormonal signaling, changes in the gut microbiome and mucosal barrier function, and activation of innate immune reactions caused by an excess of free fatty acids, bacterial lipopolysaccharides, chemokines, cytokines, and adipokines.…”