TY - JOUR
T1 - Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty
AU - Hajifathalian, Kaveh
AU - Mehta, Amit
AU - Ang, Bryan
AU - Skaf, Daniel
AU - Shah, Shawn L.
AU - Saumoy, Monica
AU - Dawod, Qais
AU - Dawod, Enad
AU - Shukla, Alpana
AU - Aronne, Louis
AU - Brown, Robert S.
AU - Cohen, David E.
AU - Dannenberg, Andrew J.
AU - Fortune, Brett
AU - Kumar, Sonal
AU - Sharaiha, Reem Z.
N1 - Funding Information:
DISCLOSURE: Dr Sharaiha has consulted for Boston Scientific, Cook Medical, and Olympus. Dr Aronne reports receiving consulting fees from and serving on advisory boards for Jamieson Laboratories, Pfizer, Novo Nordisk, Eisai, Real Appeal, Janssen, and Gelesis; receiving research funding from Aspire Bariatrics, Allurion, Eisai, AstraZeneca, Gelesis and Janssen, and Novo Nordisk; having equity interests in Intellihealth/BMIQ, ERX, Zafgen, Gelesis, MYOS, and Jamieson Laboratories; and serving on a board of directors for Intellihealth/BMIQ, MYOS. and Jamieson Laboratories. All other authors disclosed no financial relationships.
Publisher Copyright:
© 2021
Copyright © 2021. Published by Elsevier Inc.
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - Fibrosis
KW - Gastroplasty
KW - Humans
KW - Insulin Resistance
KW - Liver Cirrhosis/surgery
KW - Non-alcoholic Fatty Liver Disease/surgery
KW - Prospective Studies
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U2 - 10.1016/j.gie.2020.08.023
DO - 10.1016/j.gie.2020.08.023
M3 - Article
C2 - 32861753
AN - SCOPUS:85100651654
SN - 0016-5107
VL - 93
SP - 1110
EP - 1118
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 5
ER -