Aparato Digestivo. Endoscopia, Gastrodex. Hospital Universitario Dexeus, España.
Hepatología y Metabolismo, Hospital Universitario Dexeus, España.
Rev Esp Enferm Dig. 2019 Apr;111(4):283-293. doi: 10.17235/reed.2019.5949/2018.
non-alcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic hepatopathy in our environment. However, the benefits of the bariatric endoscopy in this disease are barely documented.
to evaluate changes in NAFLD, via non-invasive methods in obese patients who underwent bariatric restrictive endoscopy. Weight, metabolic changes and the level of technical safety were also analyzed as secondary objectives.
thirty patients with NAFLD and obesity (mean BMI 38.22 ± 6.55 kg/m2) underwent bariatric restrictive endoscopy; this included 15 one-year intragastric balloons and 15 sutured gastroplasties (ESG-Apollo®). A non-invasive prospective analysis was performed via analytical (hepatic function, insulin-resistance and hepatic steatosis/fibrosis scores) and ultrasonographic parameters. In addition, anthropometric features and the evolution of the main obesity-related comorbidities were evaluated. The follow-up period was one year in all cases.
thirty patients were included; 63% were female with a mean age of 46 ± 13.8 years. There was a decrease in FLI, HSI, NAFLD-Fibrosis Score, hepatic ultrasonographic steatosis, subcutaneous fat (p < 0.001), HOMA-IR, insulin and triglycerides (p < 0.05) after 12 months. An average EWL of 44.02% (16.34% TBWL) was obtained after one year, with EWL > 25% in 27/30 patients (TBWL > 10% in 25/30 patients) (p < 0.001). Obesity-related comorbidities were resolved in 17/30 (57%) of cases, 5/8 (62.5%) HTA, 5/12 (41.7%) DLP, 2/4 (50%) T2DM, 2/3 (66.7%) SOAS and 3/3 (100%) arthropathy. An improvement in HbA1c in the ESG-Apollo group (p = 0.017) was the only difference. One migrated and spontaneously expelled balloon was the only technical incidence.
bariatric endoscopy could be proposed during short-term follow-up as an effective and safe alternative in patients with obesity and NAFLD. It stimulates weight loss and improves analytical and ultrasound parameters from hepatic fat, insulin-resistance and hypertriglyceridemia. It also improves associated major comorbidities.
非酒精性脂肪性肝病（NAFLD）是我们环境中慢性肝病最常见的原因。然而，减重内镜在这种疾病中的益处几乎没有被记录下来。
评估肥胖患者接受减重限制性内镜治疗后，通过非侵入性方法对 NAFLD 的变化。体重、代谢变化和技术安全性水平也被分析为次要目标。
30 例 NAFLD 合并肥胖患者（平均 BMI 38.22±6.55kg/m2）接受减重限制性内镜治疗；其中 15 例行 1 年胃内气囊，15 例行缝合胃成形术（ESG-Apollo®）。通过分析（肝功能、胰岛素抵抗和肝脂肪变性/纤维化评分）和超声参数进行非侵入性前瞻性分析。此外，评估了人体测量特征和主要肥胖相关合并症的演变。所有病例的随访时间均为 1 年。
共纳入 30 例患者；女性占 63%，平均年龄为 46±13.8 岁。12 个月后，FLI、HSI、NAFLD-Fibrosis 评分、肝超声脂肪肝、皮下脂肪（p<0.001）、HOMA-IR、胰岛素和甘油三酯（p<0.05）均下降。一年后平均 EWL 为 44.02%（TBWL 为 16.34%），30 例中有 27 例 EWL>25%（30 例中有 25 例 TBWL>10%）（p<0.001）。30 例中有 17 例（57%）肥胖相关合并症得到解决，8 例高血压（HTA）中有 5 例（62.5%），12 例高脂血症（DLP）中有 5 例（41.7%），2 例 2 型糖尿病（T2DM）中有 2 例（66.7%），3 例非酒精性脂肪性肝炎（SOAS）中有 2 例（50%），3 例关节炎中有 3 例（100%）。ESG-Apollo 组 HbA1c 改善（p=0.017）是唯一的差异。唯一的技术并发症是一个迁移并自行排出的气球。
在短期随访中，减重内镜可作为肥胖合并 NAFLD 患者的有效和安全替代治疗方法。它可促进体重减轻，并改善肝脏脂肪、胰岛素抵抗和高甘油三酯血症的分析和超声参数。它还改善了相关的主要合并症。
