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.
Similar content being viewed by others
References
Swinburn BA, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378:804–814.
Peeters A, et al. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003;138:24–32.
Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications. Gastroenterology. 2012;142:711–725. e6.
Chalasani N, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Am J Gastroenterol. 2012;107:811–826.
Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–1231.
Adams LA, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129:113–121.
Charlton M. Evolving aspects of liver transplantation for nonalcoholic steatohepatitis. Curr Opin Organ Transplant. 2013;18:251–258.
Promrat K, et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology. 2010;51:121–129.
Peng L, Wang J, Li F. Weight reduction for non-alcoholic fatty liver disease. Cochrane Database Syst Rev. 2011;6:CD003619.
Keating SE, et al. Exercise and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Hepatol. 2012;57:157–166.
Thoma C, Day CP, Trenell MI. Lifestyle interventions for the treatment of non-alcoholic fatty liver disease in adults: a systematic review. J Hepatol. 2012;56:255–266.
ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy, Ginsberg GG, Chand B, Cote GA, et al. A pathway to endoscopic bariatric therapies. Gastrointest Endosc. 2011;74:943–953.
Abu Dayyeh BK, Thompson CC. Obesity and bariatrics for the endoscopist: new techniques. Therap Adv Gastroenterol. 2011;4:433–442.
Imaz I, et al. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg. 2008;18:841–846.
Lee YM, et al. Intragastric balloon significantly improves nonalcoholic fatty liver disease activity score in obese patients with nonalcoholic steatohepatitis: a pilot study. Gastrointest Endosc. 2012;76:756–760.
Brunt EM, et al. Nonalcoholic fatty liver disease (NAFLD) activity score and the histopathologic diagnosis in NAFLD: distinct clinicopathologic meanings. Hepatology. 2011;53:810–820.
Folini L, 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;51:361–368.
Forlano R, et al. Effect of the BioEnterics intragastric balloon on weight, insulin resistance, and liver steatosis in obese patients. Gastrointest Endosc. 2010;71:927–933.
Prati D, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002;137:1–10.
Dumonceau JM. Evidence-based review of the Bioenterics intragastric balloon for weight loss. Obes Surg. 2008;18:1611–1617.
Daniel S, et al. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol. 1999;94:3010–3014.
Mathiesen UL, et al. The clinical significance of slightly to moderately increased liver transaminase values in asymptomatic patients. Scand J Gastroenterol. 1999;34:85–91.
Marchesini G, et al. Aminotransferase and gamma-glutamyltranspeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome. J Endocrinol Invest. 2005;28:333–339.
Wallace TM, et al. Relationship of liver enzymes to insulin sensitivity and intra-abdominal fat. Diabetes Care. 2007;30:2673–2678.
Chen Z, Han CK, Pan LL, et al. Serum alanine aminotransferase independently correlates with intrahepatic triglyceride contents in obese subjects. Dig Dis Sci. 2014;59:2470–2476.
Thamer C, et al. Elevated serum GGT concentrations predict reduced insulin sensitivity and increased intrahepatic lipids. Horm Metab Res. 2005;37:246–251.
Lonardo A, et al. Hepatic steatosis and insulin resistance: Does etiology make a difference? J Hepatol. 2006;44:190–196.
Lee DS, et al. Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study. Arterioscler Thromb Vasc Biol. 2007;27:127–133.
Yamada J, et al. Elevated serum levels of alanine aminotransferase and gamma glutamyltransferase are markers of inflammation and oxidative stress independent of the metabolic syndrome. Atherosclerosis. 2006;189:198–205.
Dixon JB, Bhathal PS, O’Brien PE. Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement. Obes Surg. 2006;16:1278–1286.
Chalasani N, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55:2005–2023.
Ponce J, et al. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surg Obes Relat Dis. 2015;11:874–881.
Nikolic M, et al. Obesity treatment using a Bioenterics intragastric balloon (BIB)–preliminary Croatian results. Obes Surg. 2011;21:1305–1310.
Diabetes Prevention Program Research, G. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1677–1686.
Chang SH, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149:275–287.
Coakley BA, et al. Revisional bariatric surgery for failed restrictive procedures. Surg Obes Relat Dis. 2008;4:581–586.
Sjostrom L, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–752.
Mathurin P, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137:532–540.
Popov VB, Lim JK. Treatment of Nonalcoholic Fatty Liver Disease: The Role of Medical, Surgical, and Endoscopic Weight Loss. J Clin Transl Hepatol. 2015;3:230–238.
Martin M, et al. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis. 2010;6:8–15.
Ryou M, et al. Smart Self-Assembling MagnetS for ENdoscopy (SAMSEN) for transoral endoscopic creation of immediate gastrojejunostomy (with video). Gastrointest Endosc. 2011;73:353–359.
Thompson CC, et al. Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology. 2013;145:129–137. e3.
Ryou M, Ryan MB, Thompson CC. Current status of endoluminal bariatric procedures for primary and revision indications. Gastrointest Endosc Clin N Am. 2011;21:315–333.
Sanyal AJ, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology. 2011;54:344–353.
de Jonge C, et al. Endoscopic duodenal-jejunal bypass liner rapidly improves plasma parameters of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2013;11:1517–1520.
Takihata M, et al. Comparison of intragastric balloon therapy and intensive lifestyle modification therapy with respect to weight reduction and abdominal fat distribution in super-obese Japanese patients. Obes Res Clin Pract. 2014;8:e331–e338.
Tai CM, et al. Effectiveness of intragastric balloon treatment for obese patients: one-year follow-up after balloon removal. Obes Surg. 2013;23:2068–2074.
Zerrweck C, et al. Preoperative weight loss with intragastric balloon decreases the risk of significant adverse outcomes of laparoscopic gastric bypass in super-super obese patients. Obes Surg. 2012;22:777–782.
Sekino Y, et al. Time-course of changes of visceral fat area, liver volume and liver fat area during intragastric balloon therapy in Japanese super-obese patients. Intern Med. 2011;50:2449–2455.
Stimac D, et al. Intragastric balloon treatment for obesity: results of a large single center prospective study. Obes Surg. 2011;21:551–555.
Donadio F, et al. Metabolic parameters after BioEnterics Intragastric Balloon placement in obese patients. J Endocrinol Invest. 2009;32:165–168.
Ricci G, et al. Bariatric therapy with intragastric balloon improves liver dysfunction and insulin resistance in obese patients. Obes Surg. 2008;18:1438–1442.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-016-4178-2