Efficacy of endoscopic sleeve gastroplasty in the management of comorbid steatohepatitis: a systematic review and meta-analysis

Aims Non-alcoholic fatty liver disease (NAFLD) is among the major comorbid conditions of obesity. This condition, which affects about 25% of the world population, is exacerbated by other metabolic syndrome parameters, including insulin resistance, central obesity, and elevated plasma lipids. The prevalence of NAFLD among the obese and overweight populations is about 75% and 70%, respectively

Methods A comprehensive electronic search was carried out on three electronic databases, i.e., PubMed, Google Scholar, and ScienceDirect, for all relevant literature published until June 2024. After assessment using eligibility criteria determined by the authors beforehand, articles were included in the review if they met the inclusion criteria of our PICOS format. The articles included in the study were those that reported changes in non-alcoholic fatty liver symptoms after an endoscopic sleeve gastroplasty procedure. The statistical software Comprehensive Metanalysis version 3 was then used to pool the results. The management of obesity through various bariatric surgeries has proven to be the most efficacious way of reducing the metabolic and mechanical consequences of obesity. Furthermore, weight loss has been suggested to lead to a reduction in inflammation, steatosis, and fibrosis in patients with obesity and comorbid NAFLD. Therefore, this review aims to establish the efficacy of endoscopic sleeve gastroplasty in managing NAFLD symptoms in obese patients [1] [2] [3] [4].

Results Our comprehensive literature search yielded 350 articles. After a detailed analysis using our eligibility criteria, only five studies met the inclusion criteria and were thus used in the meta-analysis. The outcomes reported in the studies include NAFLD fibrosis score (NFS), hepatitis steatosis index (HIS), and changes in liver enzymes. A pooled analysis of the outcomes showed that ESG resulted in a significant decrease in the NFS score (SMD: -0.367, 95% CI [-0.575, -0.159], p=0.001), HSI score (SMD -1.46; 95% CI [ -1.756, -1.075], P<0.05). Furthermore, four studies reported outcomes of changes in alanine aminotransferase levels ((SMD: -0.641, 95% CI [-0.898, -0.247], P<0.05)

Conclusions The findings of our analysis indicate that ESG results in significant improvement in NAFLD symptoms and overall liver function. Since NAFLD is one of the significant comorbid conditions that result in mortality in obese patients, these findings provide a summary of empirical evidence that ESG is a feasible and safe treatment modality that may result in improvement in the outcomes of obese patients. However, although the feasibility and efficacy of ESG have been shown, its comparative efficacy to other conventional treatment modalities, such as intragastric balloons, has not been widely investigated. Therefore, future phase III clinical trials are required to compare the efficacy of ESG to other modalities.

Publication History

Article published online:
27 March 2025

• References

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