Jerez Diaz D, Vattikuti RD, Janak A, Yekula A, Farooq P, Ullah A, Kothari TH, Kothari S, Kaul V, Twohig P. Endoscopic sleeve gastrectomy vs traditional bariatric surgery: A paradigm shift in managing metabolic dysfunction-associated steatohepatitis and cirrhosis? World J Gastrointest Pharmacol Ther 2025; 16(4): 111074 [DOI: 10.4292/wjgpt.v16.i4.111074]
Corresponding Author of This Article
Patrick Twohig, MD, Assistant Professor, FRCPC, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14682, United States. patrick_twohig@urmc.rochester.edu
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Gastroenterology & Hepatology
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Review
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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/
Dec 5, 2025 (publication date) through Dec 9, 2025
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World Journal of Gastrointestinal Pharmacology and Therapeutics
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2150-5349
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Jerez Diaz D, Vattikuti RD, Janak A, Yekula A, Farooq P, Ullah A, Kothari TH, Kothari S, Kaul V, Twohig P. Endoscopic sleeve gastrectomy vs traditional bariatric surgery: A paradigm shift in managing metabolic dysfunction-associated steatohepatitis and cirrhosis? World J Gastrointest Pharmacol Ther 2025; 16(4): 111074 [DOI: 10.4292/wjgpt.v16.i4.111074]
World J Gastrointest Pharmacol Ther. Dec 5, 2025; 16(4): 111074 Published online Dec 5, 2025. doi: 10.4292/wjgpt.v16.i4.111074
Endoscopic sleeve gastrectomy vs traditional bariatric surgery: A paradigm shift in managing metabolic dysfunction-associated steatohepatitis and cirrhosis?
David Jerez Diaz, Rishi Devaraja Vattikuti, Allison Janak, Anuroop Yekula, Priya Farooq, Asad Ullah, Truptesh H Kothari, Shivangi Kothari, Vivek Kaul, Patrick Twohig
David Jerez Diaz, Internal Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, FL 34239, United States
Rishi Devaraja Vattikuti, Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, United States
Allison Janak, Anuroop Yekula, Asad Ullah, Truptesh H Kothari, Shivangi Kothari, Vivek Kaul, Patrick Twohig, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14682, United States
Priya Farooq, Department of Transplant Hepatology, University of Rochester Medical Center, Rochester, NY 14682, United States
Author contributions: Janak A, Vattikuti RD, Yekula A, Jerez Diaz D, Farooq P, Ullah A, Kothari TH, Kothari S, Kaul V, and Twohig P contributed to this work; Twohig P designed the study concepts and outline; Janak A, Vattikuti RD, Yekula A, Jerez Diaz D conducted the literature review and drafted the manuscript; Jerez Diaz D, Farooq P, Ullah A, Kothari TH, Kothari S, Kaul V, and Twohig P made critical revisions; all authors prepared the draft and approved the submitted version.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
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: Patrick Twohig, MD, Assistant Professor, FRCPC, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14682, United States. patrick_twohig@urmc.rochester.edu
Received: June 23, 2025 Revised: July 30, 2025 Accepted: November 7, 2025 Published online: December 5, 2025 Processing time: 166 Days and 7.1 Hours
Abstract
Metabolic dysfunction-associated steatohepatitis (MASH) has become a leading indication for liver transplantation. Bariatric surgery is a proven intervention for weight loss and metabolic improvement in MASH but concerns over surgical risk in patients with advanced liver disease has expanded interest in endoscopic sleeve gastroplasty (ESG) as a less invasive alternative. This review examine the efficacy, safety, and metabolic impact of ESG vs traditional bariatric surgery (Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy) in patients with MASH, with and without cirrhosis. We analyze current evidence on weight loss outcomes, histologic and biochemical improvements in MASH, resolution of metabolic syndrome, and perioperative risks associated with these procedures. Special attention is given to the feasibility of ESG in compensated cirrhosis (Child-Pugh A/B) and the potential role of bariatric interventions in delaying or avoiding liver transplantation. As the prevalence of MASH-related cirrhosis rises, refining bariatric strategies for this high-risk population is imperative. ESG may offer a lower procedural risk profile, but current data are largely limited to small, observational studies with short-term follow-up. A tailored, multidisciplinary approach is essential to optimize weight management and liver health in MASH patients, with future studies needed to clarify the long-term efficacy and safety of ESG in MASH.
Core Tip: Endoscopic sleeve gastroplasty (ESG) is an emerging minimally invasive option for obesity and metabolic dysfunction-associated steatohepatitis (MASH), particularly in patients with advanced liver disease who are poor surgical candidates. This review explores ESG’s potential to improve weight loss, insulin resistance, and hepatic markers, with fewer complications than traditional bariatric surgery, though current evidence remains preliminary. As the global burden of MASH grows, ESG may represent a safer, more accessible intervention, especially where liver transplantation is not feasible, while ongoing trials and individualized strategies continue to clarify its long-term role in liver care.
