Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty

Kaveh Hajifathalian, Amit Mehta, Bryan Ang, Daniel Skaf, Shawn L. Shah, Monica Saumoy, Qais Dawod, Enad Dawod, Alpana Shukla, Louis Aronne, Robert S. Brown, David E. Cohen, Andrew J. Dannenberg, Brett Fortune, Sonal Kumar, Reem Z. Sharaiha

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


BACKGROUND AND AIMS: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States and is closely associated with obesity and insulin resistance (IR). Weight loss is the best treatment for NAFLD. Endoscopic sleeve gastroplasty (ESG) is a promising endoscopic procedure for treatment of obesity. Our aim is to evaluate the change in IR and estimated hepatic steatosis and fibrosis after ESG.

METHODS: One hundred eighteen patients with obesity and NAFLD underwent ESG and were followed for 2 years. Weight loss was evaluated as % total body weight loss. IR was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). The previously validated hepatic steatosis index and NAFLD fibrosis score were used to estimate hepatic steatosis and risk of fibrosis.

RESULTS: Patients' mean body mass index was 40 ± 7 kg/m 2 at baseline. Eighty-four percent of patients completed 2 years of follow-up. At 2 years, the mean total body weight loss was 15.5% (95% confidence interval, 13.3%-17.8%). Patients' HOMA-IR improved significantly from 6.7 ± 11 to 3.0 ± 1.6 after only 1 week from ESG (P = .019) with continued improvement up to 2 years (P = .03). Patients' hepatic steatosis index score improved significantly, decreasing by 4 points per year (P for trend, <.001). Patients' NAFLD fibrosis score improved significantly, decreasing by 0.3 point per year (P for trend, .034). Twenty-four patients (20%) improved their risk of hepatic fibrosis from F3-F4 or indeterminate to F0-F2, whereas only 1 patient (1%) experienced an increase in the estimated risk of fibrosis (P = .02).

CONCLUSIONS: Our results suggest a significant and sustained improvement in estimated hepatic steatosis and fibrosis after ESG in patients with NAFLD. Importantly, we showed an early and weight-independent improvement in insulin resistance, which lasted for 2 years after the procedure.

Original languageEnglish (US)
Pages (from-to)1110-1118
Number of pages9
JournalGastrointestinal Endoscopy
Issue number5
StatePublished - May 2021


  • Fibrosis
  • Gastroplasty
  • Humans
  • Insulin Resistance
  • Liver Cirrhosis/surgery
  • Non-alcoholic Fatty Liver Disease/surgery
  • Prospective Studies

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging


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