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June 02, 2020
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Intragastric balloon facilitates metabolic improvements in NASH

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Endoscopically placed intragastric balloons appeared to be safe and effective for the management of NASH, according to research published in Clinical Gastroenterology and Hepatology.

Barham K. Abu Dayyeh, MD, MPH, director of advanced endoscopy at Mayo Clinical in Rochester, Minnesota, and colleagues wrote that it can be difficult for patients with NASH to achieve more than 10% total body weight lost (TBWL) with diet and dietary interventions alone, which is needed to achieve meaningful improvements.

Infographic on the key findings of a study of intragastric balloons on NASH.
Endoscopically placed intragastric balloons appeared to be safe and effective for the management of NASH.

“On the other hand, bariatric surgery, the most effective therapy for obesity, is not appropriate for those with mild to moderate obesity; nor is it a desired intervention for the majority of patients who qualify for it,” they wrote. “Endoscopic bariatric therapies are garnering more attention as potential strategies to address these shortcomings in obesity care and its comorbidities; however, their influences on the driving and prognostic parameters of NAFLD remain unclear.”

Researchers conducted an open-label, prospective study to explore the impact of intragastric balloons (IGB) on metabolic and histologic features of NASH. They enrolled 21 patients with early hepatic fibrosis (81% women; mean age, 54 years; average BMI, 44 kg/m2) who underwent magnetic resonance elastography and endoscopic ultrasound with core live biopsy collection at the time of IGB placement.

The primary outcome measure was the changes in liver histology parameters at IGB, including change in nonalcoholic fatty liver disease activity score (NAS) and fibrosis score. Investigators also assessed change in body weight, BMI and other measures.

Six months following IGB placement, the mean TBWL was 11.7% ± 7.7% with reductions in HbA1c (1.3% ± 0.5%; P = .02).

Researchers observed NAS improvement in 90% of patients with a median decrease of 3 points, while 80% of patients had an improvement of at least 2 points. Fibrosis improved by 1.17 stages in 15% of patients and MRE-detected fibrosis improved by 1.5 stages in 50% of patients.

“The IGB is a safe and effective treatment for NAFLD, which may allow a reversal in the natural history of NAFLD and NASH, despite the short duration of the intervention,” Abu Dayyeh and colleagues wrote. “The logistics of IGB placement will enable accurate risk stratification of these patients in a safe and reproducible manner, obviating the need for additional investigations, and clarifying the real risk of patients afflicted with NAFLD.”