Abstract
Many obese people with type 2 diabetes develop non-alcoholic fatty liver disease,
which may progress to liver fibrosis. EndoBarrier gastrointestinal liner is an innovative
interventional treatment option for type 2 diabetic patients, which could affect diabetes
associated liver disease. The aim of this retrospective study was to analyze the effect
of 1-year EndoBarrier therapy on liver fibrosis and steatosis. As an indicator of
fibrosis, liver stiffness was assessed by liver elastography at baseline, 2 weeks
after EndoBarrier implantation and then every 3 months until explantation. 13/19 patients
had elevated liver stiffness at baseline, corresponding to liver fibrosis grade 2
to 4. In these patients, liver stiffness reduced significantly during EndoBarrier
therapy from 10.4 kPa (IQR 6.0–14.3) at baseline to 5.3 kPa (IQR 4.3–7.7, p<0.01)
by the time of EndoBarrier explantation, corresponding to a normalization of the initially
pathologic findings in most patients. Liver steatosis was also assessed by elastographic
measurements in terms of the controlled attenuation parameter. In all patients, baseline
measurements showed high grade steatosis. Improvements were seen from initially 343 dB/m
(IQR 326–384) to 317 dB/m (IQR 269–375, p<0.05) by the time of explantation. However,
most patients were still classified high grade steatosis after completion of EndoBarrier
treatment. In this observational study, we show that liver fibrosis is a common condition
in obese patients suffering from type 2 diabetes, and that EndoBarrier gastrointestinal
liner substantially improves liver fibrosis in these patients.
Key words
NAFLD - steatosis - Obesity - fibroscan - liver stiffness
