Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Clin Gastroenterol Hepatol. 2022 Mar;20(3):511-524.e1. doi: 10.1016/j.cgh.2021.03.017. Epub 2021 Mar 13.
BACKGROUND & AIMS: Weight loss via lifestyle intervention remains the mainstay of treatment for nonalcoholic fatty liver disease (NAFLD). Endoscopic bariatric and metabolic therapies (EBMTs) have recently been developed as an alternative treatment option for obesity. This study aimed to assess the effect of FDA-approved EBMTs on NAFLD.
We searched MEDLINE, EMBASE, Web of Science and Cochrane Central through December 2020 for studies that assessed changes in liver outcomes following EBMT. Primary Outcomes: Liver fibrosis.
Liver biochemistry, steatosis, NAFLD histological changes and insulin sensitivity. The Grading of Recommendations, Assessment, Development, and Evidence (GRADE) approach was conducted to assess quality of evidence.
Of 4994 potential studies, 18 studies with 863 patients were included. Average weight loss was 14.5% of initial weight at a 6-month follow-up. Primary outcomes: Following EBMT, liver fibrosis significantly reduced by standardized mean difference (SMD) of 0.7 (95% CI, 0.1, 1.3; P = .02).
There were significant improvements in other NAFLD surrogates including alanine aminotransferase (-9.0 U/L; 95% CI, -11.6, -6.4; P < .0001), hepatic steatosis (SMD: -1.0; 95% CI, -1.2, -0.8; P < .0001) and histologic NAFLD activity score (-2.50; 95% CI, -3.5, -1.5; P < .0001). Other metabolic parameters including insulin resistance and waist circumference also significantly improved. The overall quality of the evidence for primary outcomes was low to very low.
EBMTs appear effective at treating NAFLD with significant improvement in liver fibrosis. Given the worsening NAFLD pandemic and limitations of currently available therapies, EBMTs should be further investigated as a potential treatment option for this patient population.
通过生活方式干预减轻体重仍然是非酒精性脂肪性肝病（NAFLD）的主要治疗方法。内镜减重和代谢治疗（EBMT）最近已作为肥胖症的另一种治疗选择而开发。本研究旨在评估经 FDA 批准的 EBMT 对 NAFLD 的影响。
我们通过 MEDLINE、EMBASE、Web of Science 和 Cochrane Central 检索了截至 2020 年 12 月评估 EBMT 后肝脏结局变化的研究。主要结局：肝纤维化。次要结局：肝功能、脂肪变性、NAFLD 组织学变化和胰岛素敏感性。使用推荐评估、制定与评价分级（GRADE）方法评估证据质量。
在 4994 项潜在研究中，纳入了 18 项研究的 863 例患者。平均体重减轻量为初始体重的 14.5%，随访 6 个月。主要结局：EBMT 后，肝纤维化的标准化均数差（SMD）显著降低 0.7（95%CI，0.1，1.3；P =.02）。次要结局：包括丙氨酸氨基转移酶（-9.0 U/L；95%CI，-11.6，-6.4；P <.0001）、肝脂肪变性（SMD：-1.0；95%CI，-1.2，-0.8；P <.0001）和组织学 NAFLD 活动评分（-2.50；95%CI，-3.5，-1.5；P <.0001）在内的其他 NAFLD 替代指标均显著改善。其他代谢参数如胰岛素抵抗和腰围也显著改善。主要结局的证据总体质量为低至极低。
EBMT 似乎对治疗 NAFLD 有效，肝纤维化显著改善。鉴于 NAFLD 流行情况恶化以及现有治疗方法的局限性，应进一步研究 EBMT 作为该患者人群的潜在治疗选择。
