Impact of metabolic endoscopy on fibrosis regression in steatotic liver disease

Table 1 Fibrosis reduction in patients with fatty liver disease undergoing metabolic bariatric procedures¹

Ref.	Study design	Population	Intervention	Key findings
Abad et al[12], 2024	Multicenter, randomized, clinical trial	40 patients with MASH	ESG with lifestyle modification vs sham endoscopy with lifestyle intervention	The ESG group achieved significantly greater total body weight loss (9.47% vs 3.91%) and a greater reduction in liver stiffness (5.63 vs 0.2 kPa, both P < 0.05)
Hajifathalian et al[15], 2021	Prospective, single-arm interventional study	118 patients with obesity and MASLD or MASH	ESG	ESG reduced hepatic fibrosis risk in 20% of patients, shifting VCTE elastography readings from F3–F4 to F0–F2, while only 1% worsened (P = 0.02)
Nunes et al[28], 2023	Systematic review and meta-analysis	175 patients with obesity and MASLD	Four studies: ESG	Sgnificantly reduced hepatic steatosis index (–4.85, 95%CI –6.02 to –3.67), NFS (–0.5, 95%CI –0.80 to –0.19), TWL (–17.28%, 95%CI –18.24 to –16.31)
Jirapinyo et al[29], 2022	Systematic review and meta-analysis	Study sample sizes ranged from 21 to 29 patients with obesity and MASLD	One study ESG; One study IGB	EBMTs significantly reduced liver fibrosis (SMD 0.7, 95%CI: 0.1–1.3, P = 0.02), hepatic steatosis (SMD –1.0, 95%CI: –1.2 to –0.8, P < 0.0001) and NAS (–2.50, 95%CI: –3.5 to –1.5, P < 0.0001)
Salomone et al[18], 2021	Retrospective study	26 patients with obesity and MASH (liver stiffness ≥ 9.7 kPa at baseline)	IGB	FIB-4 decreased from 3.2 ± 0.7 to 2.7 ± 0.8, liver stiffness from 13.3 ± 3.2 to 11.3 ± 2.8 kPa, and CAP from 355 (298–400) to 296 (255–352) dB/m (all P < 0.01); no severe adverse events
Ren et al[30], 2022	Systematic review and meta-analysis	Study sample sizes ranged from 21 to 91 patients with obesity and MASLD or MASH	Two studies: IGB; One study DJBL	NFS decreased by –0.58 (95%CI –0.97 to –0.20), APRI lowered by 0.73 (P = 0.005) and MRE stiffness by 0.3 kPa (P = 0.03); VCTE elastography (–6.39 kPa) and FIB-4 (–0.28) changes were non-significant
Roehlen et al[21], 2022	Prospective interventional study	71 patients with T2DM, obesity and MASLD	DJBL	Significantly reduced fatty liver index (from 98.22 to 93.38, P < 0.001), NFS (from 0.19 to –0.83, P < 0.001), and APRI (from 0.36 to 0.26, P < 0.0001)
Karlas et al[22], 2022	Retrospective study	32 T2D patients with obesity undergoing DJBL	DJBL	Reduced FAST score by 0.21 (95%CI: –0.28 to –0.13, P < 0.001); fibrosis markers (LSM, NFS, ELF) were unchanged, with slight FIB4 improvement; device-related complications were noted
Chuang et al[19], 2023	Systematic review and meta-analysis	67 patients with obesity and MASLD or MASH (biopsy-proven or MRI-PDFF > 5%)	Two studies: DMR	Trend toward reduced liver fat (MRI-PDFF decreased by –2.22, 95%), though results were not statistically significant (P > 0.05)
Jirapinyo et al[17], 2024	Retrospective study from a prospectively collected registry	30 patients with obesity and MASLD	12 patients received EGR monotherapy, 18 patients received EGR+GLP-1RA	Combination therapy led to significantly greater fibrosis improvement: NFS decreased by 181% ± 182% vs 30% ± 83% (P = 0.04), and liver stiffness reduced by 54% ± 12% vs 14% ± 45% (P = 0.05)

¹All the studies had a follow-up between 6 months and 2 years.

APRI: Aspartate aminotransferase to platelet ratio index; CAP: Controlled attenuation parameter; DJBL: Duodenal-jejunal bypass liner; DMR: Duodenal mucosal resurfacing; EBMTs: Endoscopic bariatric and metabolic therapies; ERG: Endoscopic revisional gastroplasty; FIB-4: Fibrosis-4 index; FAST: Fibroscan- aspartate aminotransferase score; GLP-1RA: Glucagon-like peptide-1 receptor agonist; IGB: Intragastric balloon; MASLD: Metabolic dysfunction-associated steatotic liver disease; MASH: Metabolic dysfunction-associated steatohepatitis; MRI-PDFF: Magnetic resonance imaging proton density fat fraction; NAS: Non-alcoholic fatty liver disease activity score; T2D: Type 2 diabetes; TBWL: Total body weight loss; VCTE: Vibration-controlled transient elastography.