Mandour MO, El-Hassan M, Elkomi RM, Oben JA. Non-alcoholic fatty liver disease: Is surgery the best current option and can novel endoscopy play a role in the future? World J Hepatol 2022; 14(9): 1704-1717 [PMID: 36185721 DOI: 10.4254/wjh.v14.i9.1704]
Corresponding Author of This Article
Mandour Omer Mandour, MBBS, MRCP, DTM RCSI, Department of Gastroenterology and Hepatology, Guys & St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom. omer.mandour@nhs.net
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Sep 27, 2022; 14(9): 1704-1717 Published online Sep 27, 2022. doi: 10.4254/wjh.v14.i9.1704
Non-alcoholic fatty liver disease: Is surgery the best current option and can novel endoscopy play a role in the future?
Mandour Omer Mandour, Mohammed El-Hassan, Rawan M Elkomi, Jude A Oben
Mandour Omer Mandour, Mohammed El-Hassan, Rawan M Elkomi, Jude A Oben, Department of Gastroenterology and Hepatology, Guys & St Thomas Hospital, London, SE1 7EH, United Kingdom
Jude A Oben, King’s College London, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London SE1 7EH, United Kingdom
Author contributions: All authors contributed to writing, have read and approved of the final manuscript.
Conflict-of-interest statement: Jude Oben served as a consultant for Apollo Endosurgery. The remaining authors have no potential competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mandour Omer Mandour, MBBS, MRCP, DTM RCSI, Department of Gastroenterology and Hepatology, Guys & St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom. omer.mandour@nhs.net
Received: March 9, 2022 Peer-review started: March 9, 2022 First decision: June 22, 2022 Revised: July 4, 2022 Accepted: August 1, 2022 Article in press: August 1, 2022 Published online: September 27, 2022 Processing time: 197 Days and 7.1 Hours
Abstract
Over the last decade, non-alcoholic fatty liver disease (NAFLD) has overtaken alcohol as the leading cause of cirrhosis in the Western world. There remains to be a licensed pharmacological treatment for NAFLD. Weight loss is advised for all patients with NAFLD. Many patients however, struggle to lose the recommended weight with lifestyle modification alone. Many drugs have either failed to show significant improvement of steatosis or are poorly tolerated. Bariatric surgery has been shown to reduce liver steatosis and regress liver fibrosis. The pathophysiology is not fully understood, however recent evidence has pointed towards changes in the gut microbiome following surgery. Novel endoscopic treatment options provide a minimally invasive alternative for weight loss. Randomised controlled trials are now required for further clarification.
Core Tip: The overstitch endoscopic suturing system (Overstitch; Apollo Endosurgery, Austin, Tex) which was first reported in 2013, allows sleeve gastropexy to be performed by placing full-thickness sutures through the gastric wall from the pre-pyloric antrum to the gastro-oesophageal junction. Performed using flexible endoscopy, it has the advantage of being less invasive with no permanent visible scar and evidence suggestive of fewer complications compared to laparoscopic sleeve gastrectomy. There is now mounting evidence not only showing benefits in terms of weight loss but also improvements in other metabolic markers including Hemoglobin A1c, blood pressure and alanine aminotransferase, making endoscopic sleeve gastroplasty potentially a viable treatment option for non-alcoholic fatty liver disease in the future.
