Endoscopic Sleeve Gastroplasty in Treatment of NAFLD

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A total of 118 patients with obesity and NAFLD (nonalcoholic fatty liver disease), underwent endoscopic sleeve gastroplasty (ESG) and were followed for 2 years. Weight loss was evaluated as percentage total body weight loss. Insulin resistance (IR) was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR).

Previously evaluated hepatic steatosis index and NAFLD fibrosis score were used to estimate hepatic steatosis and risk of fibrosis.

Lean body mass index was 40 kg/m². At baseline, 84% of patients completed 2 years of follow-up. At 2 years, the mean total body weight loss was 15.5%.  Patients’ HOMA-IR improved significantly from 6.7 average to 3 average after one week from ESG performance, with continued improvement up to 2 years. Patient’s hepatic steatosis index score improved significantly, decreasing by 4 points per year. Patient’s NAFLD fibrosis score improved significantly, decreasing by 0.3 per year. A total of 24 patients (20%), improved their risk of hepatic fibrosis from F3 to F4, or indeterminate to F0 to F2, whereas only 1% experienced an increase in the estimated risk of fibrosis. It was concluded there was a significant and sustained improvement in estimated hepatic steatosis and fibrosis after ESG in patients with NAFLD and it was demonstrated early and weight-independent improvement in insulin resistance, which lasted for 2 years after the procedure.

Hajifathalkian, K., Mehta, A., Ang, B., et al. “Improvement in Insulin Resistance and Estimated Hepatic Steatosis and Fibrosis After Endoscopic Sleeve Gastroplasty.”  Gastrointestinal Endoscopy 2021; Vol. 93, pp. 1110-1118.

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