Sierra L, Chatterjee A, Prado R, Khurana A, Patel R, Firkins S, Simons-Linares R. Impact of metabolic endoscopy on fibrosis regression in steatotic liver disease. World J Hepatol 2025; 17(9): 108144 [DOI: 10.4254/wjh.v17.i9.108144]
Corresponding Author of This Article
Roberto Simons-Linares, MD, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States. simonsc@ccf.org
Research Domain of This Article
Research & Experimental Medicine
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, 2025; 17(9): 108144 Published online Sep 27, 2025. doi: 10.4254/wjh.v17.i9.108144
Impact of metabolic endoscopy on fibrosis regression in steatotic liver disease
Leandro Sierra, Arjun Chatterjee, Renan Prado, Akash Khurana, Roma Patel, Stephen Firkins, Roberto Simons-Linares
Leandro Sierra, Renan Prado, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Arjun Chatterjee, Akash Khurana, Roma Patel, Stephen Firkins, Roberto Simons-Linares, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: Sierra L conceived the study, designed the protocol, performed the literature search and data extraction, prepared all figures and tables, and drafted the initial manuscript; Chatterjee A assisted with study design, figure generation, and provided substantial revisions; Prado R supported the literature search, verified data and aided in early drafting; Khurana A helped revise manuscript sections; Patel R formatted figures, and critically reviewed the manuscript for clarity; Firkins S ensured data-quality control, and offered critical intellectual feedback; Simons-Linares R supervised the project, secured resources, and performed senior revisions; all authors approved the final version and agree to be accountable for the work.
Conflict-of-interest statement: The authors do not have conflicts of interests associated to this work.
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: Roberto Simons-Linares, MD, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States. simonsc@ccf.org
Received: April 8, 2025 Revised: June 13, 2025 Accepted: August 4, 2025 Published online: September 27, 2025 Processing time: 172 Days and 17.5 Hours
Abstract
Metabolic endoscopy represents a promising alternative in the management of steatotic liver disease, particularly metabolic dysfunction-associated steatohepatitis (MASH), a progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD). With the rising global prevalence of MASLD—affecting over one-third of the adult population—and its close association with obesity, insulin resistance, and metabolic syndrome, there is an urgent need for innovative, minimally invasive therapies that can reverse liver fibrosis and prevent progression to cirrhosis and hepatocellular carcinoma. Traditional management of MASLD relies on lifestyle modifications and bariatric surgery, yet these approaches are hampered by issues of adherence, invasiveness, and accessibility. This review examines endoscopic bariatric metabolic therapies including endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGB), duodenal mucosal resurfacing (DMR), and duodeno-jejunal bypass liners (DJBL), as well as revisional procedures like endoscopic revisional gastroplasty (ERG) and transoral outlet reduction (TORe). Clinical studies and meta-analyses indicate that metabolic endoscopy is safe and effective for liver fibrosis in MASH. ESG appears to offer the greatest fibrosis reduction, while IGB and DJBL yield modest improvements, and DMR shows no significant effect. Among revisional therapies, ERG has demonstrated fibrosis reduction, although the benefits of TORe remain to be fully evaluated.
Core Tip: This review highlights the promise of metabolic endoscopy as a minimally invasive strategy for reversing liver fibrosis in patients with metabolic dysfunction-associated steatohepatitis. It evaluates endoscopic bariatric metabolic therapies including endoscopic sleeve gastroplasty (ESG), intragastric balloon, duodenal mucosal resurfacing (DMR), and duodeno-jejunal bypass liners, along with revisional procedures such as endoscopic revisional gastroplasty (ERG) and transoral outlet reduction (TORe). Evidence indicates that ESG yields the greatest fibrosis reduction, while DMR shows minimal benefit and is not recommended. Among revisional metabolic endoscopic procedures, ERG is effective for fibrosis reduction, whereas TORe requires further evaluation.
