Endoscopic sleeve gastroplasty ‘effective alternative’ for MASH, obesity management
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Key takeaways:
- Endoscopic sleeve gastroplasty induced a greater reduction in total body weight vs. sham endoscopy (–9.47% vs. –3.91%).
- Gastroplasty also associated with a greater reduction in liver stiffness and steatosis.
Endoscopic sleeve gastroplasty with lifestyle intervention was more effective than lifestyle changes alone in achieving weight loss and histological improvement in patients with metabolic dysfunction-associated steatohepatitis and obesity.
“Endoscopic bariatric and metabolic therapies are safe and effective for the treatment of obesity and associated metabolic conditions, avoiding surgery,” Javier Abad, MD, of the department of gastroenterology and hepatology at Puerta de Hierro Majadahonda University Hospital, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Endoscopic sleeve gastroplasty (ESG) simulates a laparoscopic sleeve gastrectomy, where an endoscopic suturing device is used to place several sutures along the greater curvature of the stomach to create a tubular gastric sleeve and alter motility.”
They continued, “The current evidence of ESG in MASH is limited to retrospective series and case-control studies and we lack studies comparing ESG with standard of care.”
To investigate the safety and effectiveness of ESG, Abad and colleagues conducted a prospective, randomized, controlled, double-blind trial of 40 patients (median age, 56.5 years; 55% men; mean BMI, 37.85 kg/m2) with MASH and stage 0 to 3 fibrosis. They randomly assigned patients 1:1 to undergo either ESG or sham endoscopy followed by lifestyle intervention.
The primary outcome was MASH resolution without worsening of fibrosis during 72 weeks of follow-up; secondary outcomes included change in weight, liver fat, liver stiffness and fibrosis stage, as well as liver biochemistry.
The researchers noted 18 patients in the ESG group vs. 19 in the sham endoscopy group completed follow-up and underwent liver biopsy at the end of the study.
According to results, 94.4% vs. 57.9% of patients, respectively, achieved a “significant reduction” in body weight, with higher total body weight loss among those in the ESG group (–9.47% vs. –3.91%). Patients who achieved a weight loss of more than 10% (33.3% vs. 21.1%) demonstrated improved NAFLD activity score ([NAS] –4 vs. –0.81) but not fibrosis stage (–0.3 vs. –0.59).
Further results showed those who underwent ESG experienced a greater reduction in liver stiffness (–5.63 kPa vs. –0.2 kPa) and steatosis (–0.94 vs. –0.26). There were no differences in NAS (–1.89 vs. –1.47) or fibrosis (–0.1 vs. –0.84) between groups. Two patients from the ESG group experienced adverse events that required hospital admission but “resolved conservatively” within in 72 hours.
“These results suggest that ESG may be an effective alternative therapy in the treatment of MASH patients,” Abad and colleagues wrote. “ESG should be used as part of second-line treatment, with or without other complementary weight loss therapies, especially in patients who do not respond to lifestyle modification.”
They continued, “Further studies are needed to confirm these findings and to better characterize its potential role in the management of MASH patients.”
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