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Semin Liver Dis 2022; 42(04): 446-454
DOI: 10.1055/a-1946-6285
Review Article

Novel Endoscopic Bariatric Therapies for the Management of Nonalcoholic Steatohepatitis

Khushboo Gala
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
,
Farah Abdul Razzak
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
,
Babusai Rapaka
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
,
Barham K. Abu Dayyeh
1   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
› Author Affiliations Funding None.
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Abstract

Obesity is strongly associated with nonalcoholic fatty liver disease as well as advanced forms of the disease such as nonalcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma. While lifestyle and diet modifications have been the cornerstone of treatment for NASH thus far, they are only effective for less than half of the patients. New endoscopic bariatric therapies (EBTs) have already proved to be safe and effective for the treatment of obesity and type 2 diabetes mellitus, and may provide an intermediate, less invasive, cost-effective option for patients with NASH. In this review, we aim to describe the data and evidence as well as outline future areas of development for endobariatric therapies for the treatment of NASH. In conclusion, EBTs present an effective and safe therapeutic modality for use in the growing pandemic of obesity-related liver disease and should be investigated further with large-scale trials in this patient population.

Keywords

endoscopic bariatric and metabolic therapies - weight loss - nonalcoholic steatohepatitis - metabolic effects - obesity


Publication History

Accepted Manuscript online:
18 September 2022

Article published online:
14 October 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Ward ZJ, Bleich SN, Cradock AL. et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med 2019; 381 (25) 2440-2450
    CrossrefPubMedGoogle Scholar
  • 2 Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology 2018; 67 (01) 123-133
    CrossrefPubMedGoogle Scholar
  • 3 Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016; 64 (01) 73-84
    CrossrefPubMedGoogle Scholar
  • 4 Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116 (06) 1413-1419
    CrossrefPubMedGoogle Scholar
  • 5 Povsic M, Wong OY, Perry R, Bottomley J. A structured literature review of the epidemiology and disease burden of non-alcoholic steatohepatitis (NASH). Adv Ther 2019; 36 (07) 1574-1594
    CrossrefPubMedGoogle Scholar
  • 6 Noureddin M, Vipani A, Bresee C. et al. NASH leading cause of liver transplant in women: updated analysis of indications for liver transplant and ethnic and gender variances. Am J Gastroenterol 2018; 113 (11) 1649-1659
    CrossrefPubMedGoogle Scholar
  • 7 Patel NS, Doycheva I, Peterson MR. et al. Effect of weight loss on magnetic resonance imaging estimation of liver fat and volume in patients with nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 2015; 13 (03) 561-568.e1
    CrossrefPubMedGoogle Scholar
  • 8 Tilg H, Moschen A. Weight loss: cornerstone in the treatment of non-alcoholic fatty liver disease. Minerva Gastroenterol Dietol 2010; 56 (02) 159-167
    PubMedGoogle Scholar
  • 9 Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic steatohepatitis: a review. JAMA 2020; 323 (12) 1175-1183
    CrossrefPubMedGoogle Scholar
  • 10 Lassailly G, Caiazzo R, Ntandja-Wandji LC. et al. Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis. Gastroenterology 2020; 159 (04) 1290-1301.e5
    CrossrefPubMedGoogle Scholar
  • 11 Younus H, Sharma A, Miquel R. et al. Bariatric surgery in cirrhotic patients: is it safe?. Obes Surg 2020; 30 (04) 1241-1248
    CrossrefPubMedGoogle Scholar
  • 12 Sullivan S, Edmundowicz SA, Thompson CC. Endoscopic bariatric and metabolic therapies: new and emerging technologies. Gastroenterology 2017; 152 (07) 1791-1801
    CrossrefPubMedGoogle Scholar
  • 13 Abu Dayyeh BK, Bazerbachi F, Graupera I, Cardenas A. Endoscopic bariatric and metabolic therapies for non-alcoholic fatty liver disease. J Hepatol 2019; 71 (06) 1246-1248
    CrossrefPubMedGoogle Scholar
  • 14 Caglar E, Dobrucali A, Bal K. Gastric balloon to treat obesity: filled with air or fluid?. Dig Endosc 2013; 25 (05) 502-507
    CrossrefPubMedGoogle Scholar
  • 15 Bazerbachi F, Vargas EJ, Abu Dayyeh BK. Endoscopic bariatric therapy: a guide to the intragastric balloon. Am J Gastroenterol 2019; 114 (09) 1421-1431
    CrossrefPubMedGoogle Scholar
  • 16 Mathus-Vliegen EM, Tytgat GN. Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc 2005; 61 (01) 19-27
    CrossrefPubMedGoogle Scholar
  • 17 Abu Dayyeh BK, Maselli DB, Rapaka B. et al. Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial. Lancet 2021; 398 (10315): 1965-1973
    CrossrefPubMedGoogle Scholar
  • 18 Gollisch KSC, Raddatz D. Endoscopic intragastric balloon: a gimmick or a viable option for obesity?. Ann Transl Med 2020; 8 (Suppl. 01) S8
    CrossrefPubMedGoogle Scholar
  • 19 Chan DL, Cruz JR, Mui WL, Wong SKH, Ng EKW. Outcomes with intra-gastric balloon therapy in BMI < 35 non-morbid obesity: 10-year follow-up study of an RCT. Obes Surg 2021; 31 (02) 781-786
    CrossrefPubMedGoogle Scholar
  • 20 de Freitas Júnior JR, Ribeiro IB, de Moura DTH. et al. Effects of intragastric balloon placement in metabolic dysfunction-associated fatty liver disease: a systematic review and meta-analysis. World J Hepatol 2021; 13 (07) 815-829
    CrossrefPubMedGoogle Scholar
  • 21 Popov VB, Thompson CC, Kumar N, Ciarleglio MM, Deng Y, Laine L. Effect of intragastric balloons on liver enzymes: a systematic review and meta-analysis. Dig Dis Sci 2016; 61 (09) 2477-2487
    CrossrefPubMedGoogle Scholar
  • 22 Folini L, Veronelli A, Benetti A. et al. Liver steatosis (LS) evaluated through chemical-shift magnetic resonance imaging liver enzymes in morbid obesity; effect of weight loss obtained with intragastric balloon gastric banding. Acta Diabetol 2014; 51 (03) 361-368
    CrossrefPubMedGoogle Scholar
  • 23 Forlano R, Ippolito AM, Iacobellis A. et al. Effect of the BioEnterics intragastric balloon on weight, insulin resistance, and liver steatosis in obese patients. Gastrointest Endosc 2010; 71 (06) 927-933
    CrossrefPubMedGoogle Scholar
  • 24 Ricci G, Bersani G, Rossi A, Pigò F, De Fabritiis G, Alvisi V. Bariatric therapy with intragastric balloon improves liver dysfunction and insulin resistance in obese patients. Obes Surg 2008; 18 (11) 1438-1442
    CrossrefPubMedGoogle Scholar
  • 25 Espinet Coll E, Vila Lolo C, Díaz Galán P. et al. Bariatric and metabolic endoscopy in the handling of fatty liver disease. A new emerging approach?. Rev Esp Enferm Dig 2019; 111 (04) 283-293
    PubMedGoogle Scholar
  • 26 Nguyen V, Li J, Gan J. et al. Outcomes following serial intragastric balloon therapy for obesity and nonalcoholic fatty liver disease in a single centre. Can J Gastroenterol Hepatol 2017; 2017: 4697194
    CrossrefPubMedGoogle Scholar
  • 27 Zou ZY, Zeng J, Ren TY, Shi YW, Yang RX, Fan JG. Efficacy of intragastric balloons in the markers of metabolic dysfunction-associated fatty liver disease: results from meta-analyses. J Clin Transl Hepatol 2021; 9 (03) 353-363
    PubMedGoogle Scholar
  • 28 Chandan S, Mohan BP, Khan SR. et al. Efficacy and safety of intragastric balloon (IGB) in non-alcoholic fatty liver disease (NAFLD): a comprehensive review and meta-analysis. Obes Surg 2021; 31 (03) 1271-1279
    CrossrefPubMedGoogle Scholar
  • 29 Lee YM, Low HC, Lim LG. et al. Intragastric balloon significantly improves nonalcoholic fatty liver disease activity score in obese patients with nonalcoholic steatohepatitis: a pilot study. Gastrointest Endosc 2012; 76 (04) 756-760
    CrossrefPubMedGoogle Scholar
  • 30 Jirapinyo P, Cenaj O, Ryou M, Thompson CC. Intragastric balloons: an emerging therapy for nonalcoholic steatohepatitis and fibrosis?. ACG Case Rep J 2019; 6 (07) e00142
    CrossrefPubMedGoogle Scholar
  • 31 Salomone F, Currenti W, Magrì G, Boškoski I, Zelber-Sagi S, Galvano F. Effects of intragastric balloon in patients with nonalcoholic fatty liver disease and advanced fibrosis. Liver Int 2021; 41 (09) 2112-2116
    CrossrefPubMedGoogle Scholar
  • 32 Bazerbachi F, Vargas EJ, Rizk M. et al. Intragastric balloon placement induces significant metabolic and histologic improvement in patients with nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol 2021; 19 (01) 146-154.e4
    CrossrefPubMedGoogle Scholar
  • 33 Lavín-Alconero L, Fernández-Lanas T, Iruzubieta-Coz P. et al. Efficacy and safety of endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy in obese subjects with Non-Alcoholic SteatoHepatitis (NASH): study protocol for a randomized controlled trial (TESLA-NASH study). Trials 2021; 22 (01) 756
    CrossrefPubMedGoogle Scholar
  • 34 Abu Dayyeh BK, Rajan E, Gostout CJ. Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointest Endosc 2013; 78 (03) 530-535
    CrossrefPubMedGoogle Scholar
  • 35 Hedjoudje A, Abu Dayyeh BK, Cheskin LJ. et al. Efficacy and safety of endoscopic sleeve gastroplasty: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2020; 18 (05) 1043-1053.e4
    Google Scholar
  • 36 Jalal MA, Cheng Q, Edye MB. Systematic review and meta-analysis of endoscopic sleeve gastroplasty with comparison to laparoscopic sleeve gastrectomy. Obes Surg 2020; 30 (07) 2754-2762
    CrossrefPubMedGoogle Scholar
  • 37 Lopez-Nava G, Asokkumar R, Bautista-Castaño I. et al. Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years?. Endoscopy 2021; 53 (03) 235-243
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Li R, Veltzke-Schlieker W, Adler A. et al. Endoscopic sleeve gastroplasty (ESG) for high-risk patients, high body mass index (> 50 kg/m2) patients, and contraindication to abdominal surgery. Obes Surg 2021; 31 (08) 3400-3409
    CrossrefPubMedGoogle Scholar
  • 39 Salman MA, Salman AA, Abdelsalam A. et al. Laparoscopic sleeve gastrectomy on the horizon as a promising treatment modality for NAFLD. Obes Surg 2020; 30 (01) 87-95
    CrossrefPubMedGoogle Scholar
  • 40 Esquivel CM, Garcia M, Armando L, Ortiz G, Lascano FM, Foscarini JM. Laparoscopic sleeve gastrectomy resolves nafld: another formal indication for bariatric surgery?. Obes Surg 2018; 28 (12) 4022-4033
    CrossrefPubMedGoogle Scholar
  • 41 Asokkumar R, Lim CH, Tan AS. et al. Safety and early efficacy of endoscopic sleeve gastroplasty (ESG) for obesity in a multi-ethnic Asian population in Singapore. JGH Open 2021; 5 (12) 1351-1356
    CrossrefPubMedGoogle Scholar
  • 42 Sharaiha RZ, Kumta NA, Saumoy M. et al. Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients. Clin Gastroenterol Hepatol 2017; 15 (04) 504-510
    CrossrefPubMedGoogle Scholar
  • 43 Jagtap N, Kalapala R, Katakwar A. et al. Endoscopic sleeve gastroplasty - minimally invasive treatment for non-alcoholic fatty liver disease and obesity. Indian J Gastroenterol 2021; 40 (06) 572-579
    CrossrefPubMedGoogle Scholar
  • 44 Hajifathalian K, Mehta A, Ang B. et al. Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty. Gastrointest Endosc 2021; 93 (05) 1110-1118
    CrossrefPubMedGoogle Scholar
  • 45 Alqahtani AR, Elahmedi M, Aldarwish A, Abdurabu HY, Alqahtani S. Endoscopic gastroplasty versus laparoscopic sleeve gastrectomy: a noninferiority propensity score-matched comparative study. Gastrointest Endosc 2022; 96 (01) 44-50
    CrossrefPubMedGoogle Scholar
  • 46 Marinos G, Eliades C, Raman Muthusamy V, Greenway F. Weight loss and improved quality of life with a nonsurgical endoscopic treatment for obesity: clinical results from a 3- and 6-month study. Surg Obes Relat Dis 2014; 10 (05) 929-934
    CrossrefPubMedGoogle Scholar
  • 47 Rothstein R, Woodman G, Swain J. et al. Transpyloric shuttle treatment improves cardiometabolic risk factors and quality of life in patients with obesity: results from a randomized, double-blind, sham-controlled trial. Gastroenterology 2019; 156: 237
    CrossrefPubMedGoogle Scholar
  • 48 Puri S, Chevalier JI, Rothstein RI. S1031 long-term weight loss outcomes of endoscopic treatment with the BAROnova Transpyloric Shuttle: a prospective observational cohort study. Am J Gastroenterol 2021; 116: S489-S490
    CrossrefPubMedGoogle Scholar
  • 49 Sullivan S, Swain JM, Woodman G. et al. Randomized sham-controlled trial evaluating efficacy and safety of endoscopic gastric plication for primary obesity: the ESSENTIAL trial. Obesity (Silver Spring) 2017; 25 (02) 294-301
    CrossrefPubMedGoogle Scholar
  • 50 Lopez-Nava G, Turro R, Maselli DB. et al. 720 primary obesity surgery endoluminal 2 (Pose2): an international multicenter prospective trial. Gastrointest Endosc 2020; 91: AB60
    CrossrefPubMedGoogle Scholar
  • 51 Lopez Nava G, Asokkumar R, Laster J. et al. Primary obesity surgery endoluminal (POSE-2) procedure for treatment of obesity in clinical practice. Endoscopy 2021; 53 (11) 1169-1173
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Abu Dayyeh BK, Turro R, Maselli DB. et al. Primary obesity surgery endoluminal 2 (pose 2.0): an international multicenter prospective trial with plication durability assessment. Gastrointest Endosc 2021; 93 (06) AB2-AB3
    CrossrefPubMedGoogle Scholar
  • 53 Lopez Nava G, Arau RT, Asokkumar R. et al. Prospective multicenter study of the Primary Obesity Surgery Endoluminal (POSE 2.0) procedure for treatment of obesity. Clin Gastroenterol Hepatol 2022; (e-pub ahead of print). DOI: 10.1016/j.cgh.2022.04.019.
    CrossrefPubMedGoogle Scholar
  • 54 de Oliveira GHP, de Moura DTH, Funari MP. et al. Metabolic effects of endoscopic duodenal mucosal resurfacing: a systematic review and meta-analysis. Obes Surg 2021; 31 (03) 1304-1312
    CrossrefPubMedGoogle Scholar
  • 55 van Baar ACG, Holleman F, Crenier L. et al. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one-year results from the first international, open-label, prospective, multicentre study. Gut 2020; 69 (02) 295-303
    CrossrefPubMedGoogle Scholar
  • 56 Hadefi A, Verset L, Pezzullo M. et al. Endoscopic duodenal mucosal resurfacing for nonalcoholic steatohepatitis (NASH): a pilot study. Endosc Int Open 2021; 9 (11) E1792-E1800
    Article in Thieme ConnectPubMedGoogle Scholar
  • 57 Jirapinyo P, Haas AV, Thompson CC. Effect of the duodenal-jejunal bypass liner on glycemic control in patients with type 2 diabetes with obesity: a meta-analysis with secondary analysis on weight loss and hormonal changes. Diabetes Care 2018; 41 (05) 1106-1115
    CrossrefPubMedGoogle Scholar
  • 58 de Jonge C, Rensen SS, Koek GH. et al. Endoscopic duodenal-jejunal bypass liner rapidly improves plasma parameters of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2013; 11 (11) 1517-1520
    CrossrefPubMedGoogle Scholar
  • 59 Gollisch KS, Lindhorst A, Raddatz D. EndoBarrier gastrointestinal liner in type 2 diabetic patients improves liver fibrosis as assessed by liver elastography. Exp Clin Endocrinol Diabetes 2017; 125 (02) 116-121
    PubMedGoogle Scholar
  • 60 Betzel B, Drenth JPH, Siersema PD. Adverse events of the duodenal-jejunal bypass liner: a systematic review. Obes Surg 2018; 28 (11) 3669-3677
    CrossrefPubMedGoogle Scholar
  • 61 Jirapinyo P, McCarty TR, Dolan RD, Shah R, Thompson CC. Effect of endoscopic bariatric and metabolic therapies on nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2022; 20 (03) 511-524.e1
    CrossrefPubMedGoogle Scholar