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Endoscopic sleeve gastroplasty — minimally invasive treatment for non-alcoholic fatty liver disease and obesity

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Introduction

Adequate weight loss can lead to reduction in steatosis, inflammation, and fibrosis in patients with obesity and non-alcoholic fatty liver disease (NAFLD). We evaluated the role of endoscopic sleeve gastroplasty (ESG) in patients with obesity and NAFLD.

Methods

In this single-center prospective study, consecutive adult patients with NAFLD who underwent ESG between November 2018 and May 2019 were included. The primary outcome was the impact of ESG on hepatic parameters: change in alanine aminotransferase (ALT), hepatic steatosis index (HSI), NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4), and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) from baseline to 6 and 12 months. Secondary outcomes included change in glycated hemoglobin (HbA1c), percentage weight loss, and safety. Analysis of variance with repeated measures was used for statistical analysis.

Results

A total of 26 patients (mean age [SD] 41.5 [9.58] years; 16 females) with mean (SD) weight of 99.43 (21.89) kg at baseline were included. There was significant improvement in ALT (mean ± SD) from baseline of 59.54 ± 17.02 IU/L to 49.50 ± 11.72 IU/L and 48.42 ± 13.22 IU/L at 6 and 12 months (p = 0.001). Mean (SD) NFS was significantly improved from 0.228 (1.00) at baseline to −0.202 (1.16) and −0.552 (1.08) at 6 and 12 months (p 0.001). Mean (SD) HSI, FIB-4, and APRI scores significantly reduced from baseline to 6 and 12 months (p = 0.001). There was 18.07% total body weight loss at 12 months, with significant improvement in HbA1c. There were no major adverse events.

Conclusion

ESG is a safe and effective treatment option for patients with NAFLD and obesity causing significant weight loss. Rigorous randomized trials are required to incorporate ESG in NAFLD treatment algorithm.

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Authors and Affiliations

  1. Department of Medical Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India

    Nitin Jagtap, Rakesh Kalapala, Mithun Sharma, Mohsin Aslam, Rajesh Gupta, P Nagaraja Rao, Rajesh Goud, Manu Tandan & D. Nageshwar Reddy

  2. Department of Metabolic and Bariatric Surgery, Asian Institute of Gastroenterology, Hyderabad, 500 082, India

    Abhishek Katakwar

  3. Department of Anesthesiology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India

    Haranath Kanakagiri & Santosh Darishetty

Authors
  1. Nitin Jagtap
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  2. Rakesh Kalapala
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Contributions

Concept and design: Nitin Jagtap, Rakesh Kalapala; Mithun Sharma; materials — Nitin Jagtap, Rakesh Kalapala, Abhishek Katakwar, Mohsin Aslam; data collection and/or processing — Nitin Jagtap, Rakesh Kalapala, Rajesh Goud; analysis and/or interpretation — Nitin Jagtap, Mithun Sharma, Rakesh Kalapala, Manu Tandan; literature search — Rakesh Kalapala, Rajesh Gupta, P Nagaraja Rao; writing manuscript — Nitin Jagtap, Rakesh Kalapala, Mithun Sharma; critical review and intellectual inputs — Haranath Kanakagiri, Santhosh Darishetty, D Nageshwar Reddy; final approval: all authors

Corresponding author

Correspondence to Nitin Jagtap.

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Conflict of interest

NJ, RK, AK, MS, MA, RG, PNR, RG, MT, HK, SD, and DNR declare no competing interests.

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The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com. The study was approved by the institutional ethics committee.

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Jagtap, N., Kalapala, R., Katakwar, A. et al. Endoscopic sleeve gastroplasty — minimally invasive treatment for non-alcoholic fatty liver disease and obesity. Indian J Gastroenterol 40, 572–579 (2021). https://doi.org/10.1007/s12664-021-01202-7

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