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Abstract Details
Improvement in Insulin Resistance and Estimated Hepatic Steatosis and Fibrosis after Endoscopic Sleeve Gastroplasty
Gastrointest Endosc. 2020 Aug 27;S0016-5107(20)34733-7. doi:10.1016/j.gie.2020.08.023.Online ahead of print.
Kaveh Hajifathalian1, Amit Mehta1, Bryan Ang2, Daniel Skaf2, Shawn Shah1, Monica Saumoy3, Qais Dawod1, Enad Dawod2, Alpana Shukla4, Louis Aronne4, Robert Brown1, David Cohen1, Andrew J Dannenberg5, Brett Fortune1, Sonal Kumar1, Reem Z Sharaiha6
Author information
1Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York.
2Joan & Sanford I. Weill Medical College of Cornell University, New York.
3Gastroenterology and hepatology Department, Perelman school of medicine, University of Pennsylvania.
4Division of Endocrinology Diabetes and Metabolism, Weill Cornell Medicine, New York-Presbyterian Hospital, New York.
5Department of Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York.
6Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York. Electronic address: rzs9001@med.cornell.edu.
Abstract
Background and aims: Non-alcoholic 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 forNAFLD. 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 (TBWL). IR was evaluated using homeostasis model assessment of insulin resistance (HOMA-IR). The previously validated hepatic steatosis index (HSI) and NAFLD fibrosis score (NFS) were used to estimate hepatic steatosis and risk of fibrosis.
Results: Patients' mean BMI was 40±7 kg/m2 at baseline. 84% of patients completed 2 years of follow-up. At 2 years, mean TBWL was 15.5% (95% CI, 13.3%-17.8%). Patients' HOMA-IR significantly improved from 6.7±11to 3.0±1.6 after only 1 week from ESG (p=0.019) with continued improvement up to 2 years (p=0.03). Patients' HSI score significantly improved, decreasing by 4 points per year (p for trend<0.001). Patients' NFS significantly improved, decreasing by 0.3 point per year (P value for trend=0.034). 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 estimates risk of fibrosis (p=0.02).
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.