Background

Nonalcoholic fatty liver disease (NAFLD) is tied to the rise in obesity and type 2 diabetes. Bariatric endoscopic interventions may provide an option to treat patients but there is scant data at present evaluating the effects on liver disease and diabetes.

Methods

Study Type: Retrospective review of prospectively-collected patients’ data at the Manhattan VA. Intervention: Intragastric balloon (IGB) for 6 months or endoscopic sleeve gastroplasty (ESG) combined with 12 monthly visits with a dietitian. Primary Outcomes: Body mass index (BMI, kg/m2), total body weight loss (TBWL, %), HbA1c, fasting glucose (FG), ALT, liver stiffness and liver steatosis by transient elastography (TE) from baseline (IGB insertion or ESG) up to 24 months.

Results

By May 2019, 12 patients had undergone IGB procedure and had at least 3 months of post-IGB follow-up. 3 patients had undergone ESG. The average TBWL was 13%±8% at IGB removal and 13%±8% with follow up to 12-24 months. ALT decreased by 36% from baseline (46 U/L±30 to 34 U/L±29). All patients with elevated HbA1c prior to intervention subsequently normalized post-intervention (Figure 1). For ESG, the average TBWL in our practice was 18.6%±0.9% with a mean HbA1c decrease from 6.9%±1.0 at the start to 5.9%±0.4 after 10 months. In patients with NAFLD, controlled attenuation parameter (CAP) decreased by 31%±6.9 and liver stiffness by TE decreased by 34%±0.9 after IGB.

Conclusions

Endoscopic bariatric therapies lead to significant improvements in obesity, NAFLD and diabetic parameters.