Endoscopic bariatric treatments improve fibrosis in NAFLD

Patients with non-alcoholic fatty liver disease who underwent endoscopic bariatric and metabolic therapies saw improvements in liver fibrosis and other outcomes, according to study results.

Christopher C. Thompson, MD, MSc, from the division of gastroenterology, hepatology and endoscopy at Brigham and Women’s Hospital, and colleagues wrote that even as relative new treatments, endoscopic bariatric and metabolic therapies (EBMT) have already shown benefits in terms of weight loss.

“Studies have demonstrated their efficacy to range from 10% to 20% total weight loss with the majority of patients achieving at least 10% total weight loss,” they wrote. “Given the established efficacy of EBMTs on weight loss and the known therapeutic effect of weight loss on NAFLD, EBMTs may serve as a new treatment category for NAFLD.”

Investigators searched the literature for studies that explored the impact of EBMTs on liver fibrosis. They also explored their impact on liver biochemistry, steatosis, NAFLD histological changes and insulin sensitivity.

Researchers identified 18 studies comprising 863 patients that fit their criteria. At 6 months of follow-up after undergoing an EBMT procedure, the average weight loss was 14.5% on initial weight.

Patients experienced a liver fibrosis reduction of a standardized mean difference of 0.7 (95% CI, 0.1-1.3). They also experienced improvements in alanine aminotransferase (–9 U/L; 95% CI, –11.6 to –6.4), hepatic steatosis (SMD: –1; 95% CI, –1.2 to –0.8) and histologic NAFLD activity score (–2.5; 95% CI, –3.5 to –1.5).

Thompson and colleagues also identified significant reductions in insulin resistance and waist circumference.

“Given the worsening NAFLD pandemic and the paucity of available therapies, EBMTs should be further investigated as a potential treatment option for this patient population,” they wrote.