Endoscopic bariatric and metabolic therapies and its effect on metabolic dysfunction-associated steatotic liver disease: a review of the current literature.

Endoscopic bariatric and metabolic therapies (EBMTs) are minimally invasive endoscopic procedures that have shown to demonstrate significant weight loss in people with obesity. While abundant data support their positive effect on weight loss, there remains a notable dearth of information regarding their effects on metabolic dysfunction-associated steatotic liver disease (MASLD). As rates of type 2 diabetes and obesity have grown worldwide, so has the rate of MASLD. Therefore, addressing these knowledge gaps is crucial in improving liver health worldwide. In this review, we aim to provide the existing evidence delineating the effects of primary and secondary endoscopic bariatric therapies on MASLD and determine knowledge gaps requiring future study. Utilizing PubMed search with relevant keywords such as "endoscopic bariatric therapies," "NAFLD" (nonalcoholic fatty liver disease), "MAFLD" (metabolic dysfunction-associated fatty liver disease), "MASLD" (metabolic dysfunction-associated steatotic liver disease), we gathered case reports, reviews, and retrospective analyses, evaluating their data and limitations. In our manuscript, we detail many primary and secondary endoscopic therapies and the literature available exploring their impact on liver health. This review demonstrates that primary EBMTs improve noninvasive liver markers, weight loss, and overall metabolic syndrome suggesting significant benefit in MASLD. There is, however, a significant lack of literature studying how primary endoscopic therapies compare amongst each other and how revisional therapies affect MASLD. We additionally offer suggestions for future research to deepen our understanding of EBMTs and their effects on MASLD.