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Effect of Intragastric Balloons on Liver Enzymes: A Systematic Review and Meta-Analysis

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Abstract

Background

Intragastric balloons (IGBs) are safe and effective in inducing weight loss in obese patients. The objective of this study was to review and analyze the available data of the effect of IGB on markers of nonalcoholic fatty liver disease (NAFLD) and liver enzymes.

Methods

Searches were performed of MEDLINE and Embase databases from inception through January 2016. Study inclusion criteria were the following: ≥5 overweight or obese adult patients undergoing intragastric balloon placement, with liver tests [alanine aminotransferase (ALT) or gamma-glutamyl transpeptidase (GGT)] or markers of NAFLD (e.g., imaging, biopsy) reported before balloon insertion and after balloon removal at 6 months.

Results

Nine observational studies and one randomized trial were identified. ALT decreased by −10.02 U/l (95 % CI, −13.2, −6.8), GGT decreased by −9.82 U/l (95 % CI, −12.9, −6.8), and BMI decreased by −4.98 kg/m2 (−5.6, −4.4) with IGB therapy. Hepatic steatosis improved from baseline after 6 months of balloon therapy by magnetic resonance imaging (fat fraction, 16.7 ± 10.9–7.6 ± 9.8, p = 0.003), ultrasound (severe liver steatosis, 52–4 %, p < 0.0001). Histological NAFLD activity score was lower after 6 months of IGB versus control with sham endoscopy and diet (2 ± 0.75 vs. 4 ± 2.25, p = 0.03).

Conclusion

The use of intragastric balloon decreases liver enzymes and is potentially an effective short-term treatment for NAFLD as part of a multidisciplinary approach. Larger, more rigorous trials are needed to confirm the effect of IGBs on NAFLD.

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Acknowledgments

This study was funded in part by the Yale Liver Center, which provided salary support for statistical analyses (MC and YD).

Author contributions

Violeta Popov: Study concept and design; acquisition of data; analysis and interpretation of data; statistical analysis, drafting of the manuscript. Christopher Thompson: Study concept and design; critical revision of the manuscript for important intellectual content; study supervision. Nitin Kumar: Acquisition of data; critical revision of the manuscript for important intellectual content. Maria Ciarleglio: Statistical analysis; critical revision of the manuscript for intellectual content. Yanhong Deng: Statistical analysis; critical revision of the manuscript for important intellectual content. Loren Laine: Study concept and design; critical revision of the manuscript for important intellectual content; study supervision.

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Correspondence to Violeta B. Popov.

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Conflict of interest

Christopher Thompson: Consultancy fees from Apollo, USGI, Olympus, Fractyl, ValenTX, Boston Scientific, Covidien; stock ownership in GI Windows; Medical Advisory Board member, Fractyl. Violeta Popov, Nitin Kumar, Maria Ciarleglio, Yanhong Deng and Loren Laine that they have no conflict of interests.

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Popov, V.B., Thompson, C.C., Kumar, N. et al. Effect of Intragastric Balloons on Liver Enzymes: A Systematic Review and Meta-Analysis. Dig Dis Sci 61, 2477–2487 (2016). https://doi.org/10.1007/s10620-016-4178-2

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  • DOI: https://doi.org/10.1007/s10620-016-4178-2

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