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Efficacy and Safety of Intragastric Balloon (IGB) in Non-alcoholic Fatty Liver Disease (NAFLD): a Comprehensive Review and Meta-analysis

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Abstract

Intragastric balloon (IGB) therapy has shown efficacy in weight loss but its role in NAFLD remains unknown. We conducted a systematic review and meta-analysis to evaluate the efficacy of IGB in NAFLD. Meta-analysis was performed to estimate the pooled proportion of patients with improvement in steatosis as determined by imaging and histology following IGB placement. Nine studies were included in our analysis. Four hundred forty-two IGBs were placed. Improvement in steatosis was seen in 79.2% of patients and NAS in 83.5% of patients, and HOMA-IR score improved in 64.5% of patients. A reduction in liver volume by CT scan was noticed in 93.9% of patients undergoing IGB placement. IGB is an effective and safe short-term therapeutic modality for patients with NAFLD.

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Abbreviations

CI:

confidence interval

NR:

not reported

NA:

not applicable

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

BMI:

body mass index

TBWL:

total body weight loss

EWL:

excess weight loss.

References

  1. Younossi ZM et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524–530.e1.

    Article  PubMed  Google Scholar 

  2. Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140(1):124–31.

    Article  PubMed  Google Scholar 

  3. Vernon G, Baranova A, Younossi Z. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34(3):274–85.

    Article  CAS  PubMed  Google Scholar 

  4. Lazo M, Hernaez R, Eberhardt MS, et al. Prevalence of nonalcoholic fatty liver disease in the United States: the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Epidemiol. 2013;178(1):38–45.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328–57.

    Article  PubMed  Google Scholar 

  6. Kleiner DE, Brunt EM, van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.

    Article  PubMed  Google Scholar 

  7. Bacon BR, Farahvash MJ, Janney CG, et al. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology. 1994;107(4):1103–9.

    Article  CAS  PubMed  Google Scholar 

  8. Fracanzani AL, Valenti L, Bugianesi E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008;48(3):792–8.

    Article  CAS  PubMed  Google Scholar 

  9. Mofrad P, Contos MJ, Haque M, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003;37(6):1286–92.

    Article  PubMed  Google Scholar 

  10. Westerouen Van Meeteren MJ, Drenth JP, Tjwa ET. Elafibranor: a potential drug for the treatment of nonalcoholic steatohepatitis (NASH). Expert Opin Investig Drugs. 2020;29(2):117–23.

    Article  CAS  PubMed  Google Scholar 

  11. Friedman SL, Neuschwander-Tetri BA, Rinella M, et al. Mechanisms of NAFLD development and therapeutic strategies. Nat Med. 2018;24(7):908–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Romero-Gómez M, Zelber-Sagi S, Trenell M. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol. 2017;67(4):829–46.

    Article  PubMed  Google Scholar 

  13. Vilar-Gomez E et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367–378.e5.

    Article  PubMed  Google Scholar 

  14. Lee Y et al. Complete resolution of nonalcoholic fatty liver disease after bariatric surgery: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019;17(6):1040–1060.e11.

    Article  PubMed  Google Scholar 

  15. Weiner JP, Goodwin SM, Chang HY, et al. Impact of bariatric surgery on health care costs of obese persons: a 6-year follow-up of surgical and comparison cohorts using health plan data. JAMA surgery. 2013;148(6):555–61.

    Article  PubMed  Google Scholar 

  16. Gulliford MC, Charlton J, Prevost T, et al. Costs and outcomes of increasing access to bariatric surgery: cohort study and cost-effectiveness analysis using electronic health records. Value Health. 2017;20(1):85–92.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dayyeh BKA, Edmundowicz S, Thompson CC. Clinical practice update: expert review on endoscopic bariatric therapies. Gastroenterology. 2017;152(4):716–29.

    Article  PubMed  Google Scholar 

  18. Frutos MD, Morales MD, Luján J, et al. Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass. Obes Surg. 2007;17(2):150–4.

    Article  PubMed  Google Scholar 

  19. 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(6):927–33.

    Article  PubMed  Google Scholar 

  20. 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(3):361–8.

    Article  CAS  PubMed  Google Scholar 

  21. 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. 2020;

  22. Nguyen V 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.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee Y-M, 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(4):756–60.

    Article  PubMed  Google Scholar 

  24. Ricci G, Bersani G, Rossi A, et al. Bariatric therapy with intragastric balloon improves liver dysfunction and insulin resistance in obese patients. Obes Surg. 2008;18(11):1438–42.

    Article  PubMed  Google Scholar 

  25. Sekino Y, Imajo K, Sakai E, 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(21):2449–55.

    Article  PubMed  Google Scholar 

  26. Takihata M, Nakamura A, Aoki K, 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(4):e331–8.

    Article  PubMed  Google Scholar 

  27. Stroup DF et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Jama. 2000;283(15):2008–12.

    Article  CAS  PubMed  Google Scholar 

  28. Agnihotri A et al. Real-world safety and efficacy of fluid-filled dual intragastric balloon for weight loss. Clin Gastroenterol Hepatol. 2018;16(7):1081–1088.e1.

    Article  PubMed  Google Scholar 

  29. Donadio F, Sburlati LF, Masserini B, et al. Metabolic parameters after BioEnterics intragastric balloon placement in obese patients. J Endocrinol Investig. 2009;32(2):165–8.

    Article  CAS  Google Scholar 

  30. Raftopoulos I, Giannakou A. The Elipse Balloon, a swallowable gastric balloon for weight loss not requiring sedation, anesthesia or endoscopy: a pilot study with 12-month outcomes. Surg Obes Relat Dis. 2017;13(7):1174–82.

    Article  PubMed  Google Scholar 

  31. Stimac D et al. Intragastric balloon treatment for obesity: results of a large single center prospective study. Obes Surg. 2011;21(5):551–5.

    Article  PubMed  Google Scholar 

  32. Tai CM, Lin HY, Yen YC, et al. Effectiveness of intragastric balloon treatment for obese patients: one-year follow-up after balloon removal. Obes Surg. 2013;23(12):2068–74.

    Article  PubMed  Google Scholar 

  33. Vargas EJ et al. Single fluid-filled intragastric balloon safe and effective for inducing weight loss in a real-world population. Clin Gastroenterol Hepatol. 2018;16(7):1073–1080.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Zerrweck C, Maunoury V, Caiazzo R, 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(5):777–82.

    Article  PubMed  Google Scholar 

  35. Sullivan S, Swain J, Woodman G, et al. Randomized sham-controlled trial of the 6-month swallowable gas-filled intragastric balloon system for weight loss. Surg Obes Relat Dis. 2018;14(12):1876–89.

    Article  PubMed  Google Scholar 

  36. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

    Article  PubMed  Google Scholar 

  37. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    Article  CAS  PubMed  Google Scholar 

  38. Sutton AJ, A.K., Jones DR, et al, Methods for meta-analysis in medical research. 2000, New York: J. Wiley.

  39. Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc. 2009;172(1):137–59.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Mohan BP, Adler DG. Heterogeneity in systematic review and meta-analysis: how to read between the numbers. Gastrointest Endosc. 2019;89(4):902–3.

    Article  PubMed  Google Scholar 

  41. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Duval S, Tweedie R. Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication Bias in meta-analysis. Biometrics. 2000;56(2):455–63.

    Article  CAS  PubMed  Google Scholar 

  43. Rothstein HR, Sutton AJ, and Borenstein M, Publication bias in meta-analysis: prevention, assessment and adjustments. 2006: John Wiley & Sons.

  44. Espinet-Coll E et al. Bariatric restrictive endoscopy procedures (one-year IB and ESG-Apollo) in the treatment of fatty liver disease (NAFLD). Initial experience. Obes Surg. 2019;29(5 Supplement):536.

    Google Scholar 

  45. Abu Dayyeh BK et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies Prepared by. Gastrointest Endosc. 2015;82(3):425–438.e5.

    Article  PubMed  Google Scholar 

  46. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists - executive summary. Endocr Pract. 2019;25(12):1346–59.

    PubMed  Google Scholar 

  47. Panel CDC. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115(12):956–61.

    Article  Google Scholar 

  48. Fakhry TK, Mhaskar R, Schwitalla T, et al. Bariatric surgery improves nonalcoholic fatty liver disease: a contemporary systematic review and meta-analysis. Surg Obes Relat Dis. 2019;15(3):502–11.

    Article  PubMed  Google Scholar 

  49. Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: a systematic review of the clinical and economic evidence. J Gen Intern Med. 2011;26(10):1183–94.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Campos GM, Khoraki J, Browning MG, et al. Changes in utilization of bariatric surgery in the United States from 1993 to 2016. Ann Surg. 2020;271(2):201–9.

    Article  PubMed  Google Scholar 

  51. Peterson, K., Anderson J., Boundy E., Ferguson L., Erickson K., Rapid evidence review of bariatric surgery in super obesity (BMI ≥ 50 kg/m. J Gen Intern Med, 2017. 32(Suppl 1): p. 56–64.

  52. Gottig S et al. Analysis of safety and efficacy of intragastric balloon in extremely obese patients. Obes Surg. 2009;19(6):677–83.

    Article  PubMed  Google Scholar 

  53. Shannon A, Alkhouri N, Carter-Kent C, et al. Ultrasonographic quantitative estimation of hepatic steatosis in children with NAFLD. J Pediatr Gastroenterol Nutr. 2011;53(2):190–5.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Lee SS, Park SH, Kim HJ, et al. Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J Hepatol. 2010;52(4):579–85.

    Article  CAS  PubMed  Google Scholar 

  55. van Werven JR, Marsman HA, Nederveen AJ, et al. Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology. 2010;256(1):159–68.

    Article  PubMed  Google Scholar 

  56. Park SH, Kim PN, Kim KW, et al. Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment. Radiology. 2006;239(1):105–12.

    Article  PubMed  Google Scholar 

  57. Gutierrez-Buey G, Núñez-Córdoba JM, Llavero-Valero M, et al. Is HOMA-IR a potential screening test for non-alcoholic fatty liver disease in adults with type 2 diabetes? Eur J Intern Med. 2017;41:74–8.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Dana Gerberi, MLIS, Librarian, Mayo Clinic Libraries, is acknowledged for the help with the systematic literature search.

Author information

Author notes

  1. Saurabh Chandan and Babu P. Mohan contributed equally to this work.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA

    Saurabh Chandan

  2. Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA

    Babu P. Mohan, Stephanie McDonough & Douglas G. Adler

  3. Section of Gastroenterology, Rush University Medical Center, Chicago, IL, USA

    Shahab R. Khan

  4. Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy

    Antonio Facciorusso

  5. Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA

    Daryl Ramai

  6. Internal Medicine, Mayo Clinic, Rochester, MI, USA

    Lena L. Kassab

  7. Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA

    Neil Bhogal

  8. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore

    Ravishankar Asokkumar & Gortrand Lopez-Nava

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Contributions

SC, AF, and DGA: conception and design and drafting of the article.

BPM, SC, SRK, NB, and LKK: study search, review, and selection.

BPM, SRK, SC, and DR: data collection and synthesis.

BPM: statistical analysis of data and interpretation of results.

All authors: critical revision of the article for important intellectual content and final approval of the article.

Corresponding author

Correspondence to Douglas G. Adler.

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DGA is consultant at Boston Scientific. All other authors declare that they have no conflict of interest.

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Chandan, S., Mohan, B.P., Khan, S.R. et al. Efficacy and Safety of Intragastric Balloon (IGB) in Non-alcoholic Fatty Liver Disease (NAFLD): a Comprehensive Review and Meta-analysis. OBES SURG 31, 1271–1279 (2021). https://doi.org/10.1007/s11695-020-05084-0

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