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

Published:August 27, 2020DOI:https://doi.org/10.1016/j.gie.2020.08.023

      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/m2 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.

      Graphical abstract

      Abbreviations:

      AE (adverse event), ALT (alanine aminotransferase), ASGE (American Society for Gastrointestinal Endoscopy), AST (aspartate aminotransferase), BMI (body mass index), CI (confidence interval), ESG (endoscopic sleeve gastroplasty), GLP-1 (glucagon-like peptide 1), HbA1c (hemoglobin A1c), HOMA-IR (homeostasis model assessment of insulin resistance), HSI (hepatic steatosis index), IR (insulin resistance), NAFLD (nonalcoholic fatty liver disease), NASH (nonalcoholic steatohepatitis), NFS (NAFLD fibrosis score), TBWL (total body weight loss)
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      Linked Article

      • Metabolic function and weight loss after endoscopic sleeve gastroplasty: resistance is futile
        Gastrointestinal EndoscopyVol. 93Issue 5
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          The ongoing SARS-coronavirus2 associated disease (COVID-19) pandemic is yet another on a growing list highlighting the negative impact of obesity on comorbid conditions and patient survival. Patients with obesity are known to have more-severe COVID-19 outcomes, including higher mortality than in age- and sex-matched individuals.1 Furthermore, obesity-associated insulin resistance has been proposed as a key factor in COVID-19 severity.2
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