Endoscopic sleeve gastroplasty may be safe for managing weight loss in NASH
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Endoscopic sleeve gastroplasty in patients with nonalcoholic steatohepatitis vs. life-style intervention alone was safe and effective for achieving weight loss correlated with significant improvements, according to a presentation at the International Liver Congress.
“Endoscopy sleeve gastroplasty is an effective and safe method to promote weight reduction associated with significant improvement in liver function test, stiffness and histological parameters compared to life-style intervention alone,” Javier Abad Guerra, MD, from Puerta de Hierro Hospital, Gastroenterology and Hepatology in Madrid, Spain, said during his presentation. “According to this interim analysis, endoscopic sleeve gastroplasty could be an option in the management of these patients failing to lose weight by life-style intervention.”
Guerra and colleagues conducted the interim analysis when 21 of 40 planned patients reached 72 weeks.
Guerra and colleagues,They randomly assigned 11 patients with biopsy proven NASH with a nonalcoholic fatty liver disease activity score 3 or over and fibrosis stage from F1 to F3 to endoscopic sleeve gastroplasty (ESG) with the OverStitch system (Apollo Endosurgery, Austin, Texas) plus lifestyle modification and 10 patients to endoscopic simulated intervention (ESI) with a diagnostic upper endoscopy plus lifestyle modification. Investigators assessed change from baseline in in body weight, liver test, Fibroscan and histological features.
According to study results, 9 of 11 patients in the ESG group achieved a body weight reduction with an average of 9.7% weight reduction compared with four of 11 in patients who underwent ESI, who had an average of 4% (P < .05). Investigators noted only patients who underwent ESG achieved more than 20% loss of their body weight.
Guerra and colleagues observed more improvements in ALT, AST and ferritin levels in the ESG group compared with the ESI group (–42.7 vs. 1.6, P < .017; –32.4 vs. 1.3, P < .045; –39.8 vs. 57.7, P < .032). In the ESG group there was a reduction in Fibroscan values of –5.80Kpa compared with 2.01 Kpa in the ESI group (P < .05). NAS score improved among patients who achieved weight loss (P < .001). Investigators noted 70% of patients who achieved weight loss were in the ESG group.
Researchers observed a higher magnitude of the improvement in patients with a weight reduction over 10% (P < .001). ESG was well tolerated by patients. There were mild adverse events in 5% of the ESG group compared with 1% in the ESI group.
Perspective
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Roberto Simons-Linares, MD, MSc
NAFLD is one of the most common etiologies of cirrhosis and it affects approximately 25% of the population worldwide. Weight loss is the standard of care and treatment for NAFLD, and endoscopic sleeve gastroplasty (ESG) is an effective and safe endoscopic weight loss intervention. A recent meta-analysis of endoscopic bariatric and metabolic therapies (EBMTs), which included two ESG studies, found that EBMTs effectively treat NAFLD and can lead to significant improvements in liver fibrosis. Specifically, after ESG the AST liver enzyme decreased by 2.9 (P < .0001) and the liver fibrosis decreased by SMD of 0.3 (–0.3 to 0.8, P = .31; I2 = 74.5, P = .05; n = 191).
References:
Jirapinyo P, et al. Clin Gastroenterol Hepatol. 2021;doi: 10.1016/j.cgh.2021.03.017.
Younossi ZM, et al. Hepatol. 2016; doi: 10.1002/hep.28431.
Collapse
Guerra JA, et al. Abstract: OS-1769. Presented at: The International Liver Congress; June 23-26 (virtual meeting).
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