Is Endoscopic Sleeve Gastroplasty the Solution?

The prevalence of obesity in the United States has reached an epidemic level and is associated with conditions such as insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD). These obesity-related diseases are not only potentially life-threatening, but they pose a tremendous financial burden on the health care system. While endoscopic bariatric procedures have evolved over the years, there are little data on disease-specific outcomes. This single-center study evaluated outcomes in obese patients who underwent endoscopic sleeve gastroplasty (ESG) in expert hands. 

Data were collected from 118 patients (mean body mass index, 40 ± 7 kg/m^2) with NAFLD who underwent ESG between 2013 and 2019 and were followed for 2 years. Mean total body weight loss after ESG was 14.6% (95% confidence interval [CI], 13.3%-15.9%; P<.001) and 15.5% (95% CI, 13.3%-17.8%; P<.001) at 6 and 24 months, respectively. IR (evaluated using homeostasis model assessment) significantly improved at 1 week after ESG from 6.7 ± 11 to 3.0 ± 1.6 (P=.019), with continued improvement at 2 years (6.7 ± 11 to 2.9 ± 2.0; P=.03). Moreover, the hepatic steatosis index (score >30 indicating NAFLD) decreased by 4 (P value <.001), and the NAFLD fibrosis score (>0.675, predictor of F3-F4 fibrosis) decreased 0.3 points per year (P=.034). Over the 2-year interval, 20% (n=24) of the patients improved their risk of hepatic fibrosis from F3-F4 or indeterminate to F0-F2, whereas only 1 patient experienced an increase in the estimated risk of fibrosis (P=.02).