Endoscopic sleeve gastroplasty an effective option for patients with NASH, obesity
Click Here to Manage Email Alerts
Endoscopic sleeve gastroplasty was more effective for weight loss than lifestyle modification alone in patients with nonalcoholic steatohepatitis and obesity, according to a speaker at EASL Congress.
“Previous studies show how lifestyle intervention with a reduction of more than 10% of body weight promotes NASH resolution and fibrosis regression,” Javier Abad Guerra, MD, a gastroenterology and hepatology specialist at Puerta de Hierro Majadahonda University Hospital, said. “Unfortunately, less than 10% of the patients achieved this goal with only diet and exercise. In recent years, endoscopic bariatric and metabolic therapies have emerged as safe and effective options to promote weight loss in obesity patients.”
Endoscopic sleeve gastroplasty is among these, Guerra noted, but, “unfortunately, the current evidence on endoscopic sleeve gastroplasty in NASH patients is limited.”
In a multicenter, randomized, double-blind study, Guerra and colleagues aimed to evaluate the safety and efficacy of endoscopic sleeve gastroplasty (ESG) among 40 patients with NASH and obesity. Patients were randomized to ESG with lifestyle modification (n = 20; mean age, 55.15 years; BMI, 37.54 kg/m2) or endoscopic simulated intervention (ESI) with lifestyle modification (n = 20; mean age, 53.05 years; BMI, 38.17 kg/m2), and underwent liver biopsy at baseline and 72 weeks. Researchers compared laboratory, elastography and histological changes between groups, which included 18 and 19 patients, respectively, by study completion.
Lifestyle changes for both groups included a restrictive diet for the first 12 weeks, followed by a low-calorie diet (1,500 kcal) up to week 72, and 150 minutes of physical activity per week, which was tracked via a wearable activity band.
According to study results, researchers observed a “significant reduction of body weight” among 94.4% of patients in the ESG group, with a mean loss of 11.03 kg and a 9.57% loss in body weight. Conversely, only 57.9% of patients in the ESI group lost weight, with a mean loss of 3.85 kg and a 3.91% loss in body weight.
Moreover, 22% of patients in the ESG group achieved a weight loss of more than 15%, Guerra noted. The greatest weight loss in both groups was achieved in the first 12 weeks.
Further, results showed a “significant improvement” in aspartate aminotransferase, alanine transaminase, gamma-glutamyl transferase and liver stiffness among patients in the ESG group vs. ESI group.
Compared with those who achieved a weight loss of less than 10% (n = 27), those who had a weight loss of greater than 10% (n = 10) had significant improvement in NAS score and all of its components, with a 70% resolution of NASH.
“Endoscopic sleeve gastroplasty is more effective than lifestyle modification for weight loss in patients with NASH and obesity,” Guerra concluded. “Weight reduction more than 10% associates with significant improvement in liver stiffness and histological parameters and promotes the resolution of NASH. Endoscopic sleeve gastroplasty could be an option in the management of obese patients with NASH failing to lose weight by lifestyle intervention.”
Collapse
Guerra JA, et al. Abstract GS-009: Endoscopic sleeve gastroplasty is an effective treatment in steatohepatitis patients: A prospective, multicenter, randomized trial. Presented at: EASL Congress; June 21-24, 2023; Vienna (hybrid meeting).
Read more about
Click Here to Manage Email Alerts