Hajifathalian Kaveh, Mehta Amit, Ang Bryan, Skaf Daniel, Shah Shawn L, Saumoy Monica, Dawod Qais, Dawod Enad, Shukla Alpana, Aronne Louis, Brown Robert S, Cohen David E, Dannenberg Andrew J, Fortune Brett, Kumar Sonal, Sharaiha Reem Z
Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York.
Joan & Sanford I. Weill Medical College of Cornell University, New York, New York.
Gastrointest Endosc. 2021 May;93(5):1110-1118. doi: 10.1016/j.gie.2020.08.023. Epub 2020 Aug 27.
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.
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.
Patients' mean body mass index was 40 ± 7 kg/m 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).
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.
非酒精性脂肪性肝病（NAFLD）是美国慢性肝病的最常见病因，且与肥胖和胰岛素抵抗（IR）密切相关。体重减轻是NAFLD的最佳治疗方法。内镜下袖状胃成形术（ESG）是一种有前景的治疗肥胖症的内镜手术。我们的目的是评估ESG后IR、估计的肝脂肪变性和纤维化的变化。
118例肥胖合并NAFLD患者接受了ESG，并随访2年。体重减轻以总体重减轻百分比来评估。使用胰岛素抵抗的稳态模型评估（HOMA-IR）来评估IR。使用先前验证的肝脂肪变性指数和NAFLD纤维化评分来估计肝脂肪变性和纤维化风险。
患者基线时的平均体重指数为40±7kg/m²。84%的患者完成了2年的随访。2年时，平均总体重减轻15.5%（95%置信区间，13.3%-17.8%）。ESG仅1周后，患者的HOMA-IR从6.7±11显著改善至3.0±1.6（P = 0.019），并持续改善至2年（P = 0.03）。患者的肝脂肪变性指数评分显著改善，每年下降4分（趋势P值，<0.001）。患者的NAFLD纤维化评分显著改善，每年下降0.3分（趋势P值，0.034）。24例患者（20%）的肝纤维化风险从F3-F4或不确定改善为F0-F2，而只有1例患者（1%）的估计纤维化风险增加（P = 0.02）。
我们的结果表明，ESG后NAFLD患者的估计肝脂肪变性和纤维化有显著且持续的改善。重要的是，我们显示胰岛素抵抗在术后早期即有改善且与体重无关，这种改善在术后持续了2年。
