METABOLIC dysfunction-associated steatohepatitis (MASH) is a significant challenge for individuals with biopsy-confirmed steatotic liver disease (SLD). Lifestyle interventions, particularly achieving a weight loss of over 10%, have been shown to resolve MASH. However, this target often proves difficult for patients to achieve. Endoscopic sleeve gastroplasty (ESG), a minimally invasive procedure, has recently gained attention as a safe and effective option for promoting weight loss, particularly in obese individuals. A multicentre, randomised, controlled, and double-blind study was conducted to evaluate the safety and efficacy of ESG in improving outcomes for patients with MASH.
The study included 40 patients with MASH, defined by a NAS score of 3 or higher and fibrosis stages between F0 and F3. Participants were randomly assigned to receive either ESG combined with lifestyle modification or a sham endoscopy (SE) paired with lifestyle interventions. Of the original cohort, 18 ESG patients and 19 SE patients completed the 72-week follow-up period. Outcomes assessed included changes in body weight, liver stiffness, liver function, and histology.
The results demonstrated that ESG facilitated significant weight loss, with patients achieving an average total body weight loss (TBWL) of 9.47%, compared to 3.91% in the SE group. Liver stiffness also decreased more in the ESG group, with a reduction of 5.63 KPa versus 0.2 KPa in the SE group. Improvements in liver steatosis were more pronounced in the ESG group as well (-0.94±0.87 vs -0.26±0.99). However, changes in NAS scores (-1.89±2.11 vs -1.47±2.01) and fibrosis (-0.1±0.91 vs -0.84±1.21) did not differ significantly between groups.
Encouragingly, patients achieving over 10% weight loss experienced marked improvements in NAS scores, although fibrosis changes were modest. ESG was well-tolerated, with only two patients experiencing adverse events, both of which resolved conservatively within 72 hours. These findings underscore ESG’s potential as a safe and effective intervention for promoting weight loss and improving liver health in patients with MASH and obesity.
Katie Wright, EMJ
Reference
Abad J et al. Endoscopic sleeve gastroplasty plus lifestyle intervention in patients with MASH: a multicentre, sham-controlled, randomized trial. Clin Gastroenterol Hepatol. 2024;DOI:10.1016/j.cgh.2024.10.027.
