Endoscopia bariátrica y metabólica en el manejo del hígado graso. ¿Una nueva vía emergente? / Bariatric and metabolic endoscopy in the handling of fatty liver disease. A new emerging approach?

Introducción: la enfermedad hepática grasa no alcohólica (EHGNA) es la causa más frecuente de hepatopatía crónica en nuestro medio. Los beneficios de la endoscopia bariátrica en esta enfermedad están escasamente documentados. Objetivo: evaluar los cambios de EHGNA, mediante métodos no invasivos, en pacientes obesos sometidos a endoscopia bariátrica restrictiva. Secundariamente, analizamos los cambios ponderales y metabólicos y el grado de seguridad técnica. Métodos: treinta pacientes con EHGNA y obesidad (índice de masa corporal [IMC] medio de 38,22 +/- 6,55 kg/m²) sometidos a endoscopia bariátrica restrictiva: 15 balones de un año y 15 gastroplastias mediante suturas (ESG-Apollo(R)). Se realiza un análisis prospectivo no invasivo mediante parámetros analíticos (función hepática, insulinorresistencia, scores de esteatosis y fibrosis hepática) y ecográficos. Además, se evalúa la evolución antropométrica y de las principales comorbilidades mayores asociadas, todo ello con seguimiento a un año. Resultados: treinta pacientes (63% mujeres, edad media 46 +/- 13,8 años). A los 12 meses presentaron disminución en FLI, HSI, NAFLD-Fibrosis Score, esteatosis hepática ecográfica y grasa subcutánea (p < 0,001) y en HOMA-IR, insulina y triglicéridos (p < 0,05). Al año, se obtuvo una pérdida del exceso de peso (PEP) del 44,02% (16,34% pérdida total de peso [PTP]), con PEP > 25% en 27/30 pacientes (PP > 10% en 25/30 pacientes) (p < 0,001). Se objetivó resolución en 17/30 (57%) de las comorbilidades asociadas: 5/8 (62,5%) hipertensión arterial (HTA), 5/12 (41,7%) dislipemia (DLP), 2/4 (50%) diabetes mellitus tipo 2 (DM2), 2/3 (66,7%) síndrome de apnea obstructiva del sueño (SAOS) y 3/3 (100%) artropatía. Comparando ambos procedimientos, la mejoría en HbA1c en el grupo de ESG-Apollo (p = 0,017) fue la única diferencia. Un balón migrado y expulsado espontáneamente fue la única incidencia técnica. Conclusiones: la endoscopia bariátrica puede postularse, en un seguimiento a corto plazo, como una alternativa eficaz y segura en aquellos pacientes obesos con EHGNA. Favorece la pérdida de peso y mejora los biomarcadores analíticos y ecográficos de grasa hepática, la insulinorresistencia, la hipertrigliceridemia y las comorbilidades mayores asociadas

Background: non-alcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic hepatopathy in our environment. However, the benefits of the bariatric endoscopy in this disease are barely documented. Objectives: to evaluate changes in NAFLD, via non-invasive methods in obese patients who underwent bariatric restrictive endoscopy. Weight, metabolic changes and the level of technical safety were also analyzed as secondary objectives. Methods: thirty patients with NAFLD and obesity (mean BMI 38.22 +/- 6.55 kg/m2) underwent bariatric restrictive endoscopy; this included 15 one-year intragastric balloons and 15 sutured gastroplasties (ESG-Apollo(R)). A non-invasive prospective analysis was performed via analytical (hepatic function, insulin-resistance and hepatic steatosis/fibrosis scores) and ultrasonographic parameters. In addition, anthropometric features and the evolution of the main obesity-related comorbidities were evaluated. The follow-up period was one year in all cases. Results: thirty patients were included; 63% were female with a mean age of 46 +/- 13.8 years. There was a decrease in FLI, HSI, NAFLD-Fibrosis Score, hepatic ultrasonographic steatosis, subcutaneous fat (p < 0.001), HOMA-IR, insulin and triglycerides (p < 0.05) after 12 months. An average EWL of 44.02% (16.34% TBWL) was obtained after one year, with EWL > 25% in 27/30 patients (TBWL > 10% in 25/30 patients) (p < 0.001). Obesity-related comorbidities were resolved in 17/30 (57%) of cases, 5/8 (62.5%) HTA, 5/12 (41.7%) DLP, 2/4 (50%) T2DM, 2/3 (66.7%) SOAS and 3/3 (100%) arthropathy. An improvement in HbA1c in the ESG-Apollo group (p = 0.017) was the only difference. One migrated and spontaneously expelled balloon was the only technical incidence. Conclusions: bariatric endoscopy could be proposed during short-term follow-up as an effective and safe alternative in patients with obesity and NAFLD. It stimulates weight loss and improves analytical and ultrasound parameters from hepatic fat, insulin-resistance and hypertriglyceridemia. It also improves associated major comorbidities

Bariatric and metabolic endoscopy in the handling of fatty liver disease. A new emerging approach?

BACKGROUND: non-alcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic hepatopathy in our environment. However, the benefits of the bariatric endoscopy in this disease are barely documented. OBJECTIVES: to evaluate changes in NAFLD, via non-invasive methods in obese patients who underwent bariatric restrictive endoscopy. Weight, metabolic changes and the level of technical safety were also analyzed as secondary objectives. METHODS: thirty patients with NAFLD and obesity (mean BMI 38.22 ± 6.55 kg/m2) underwent bariatric restrictive endoscopy; this included 15 one-year intragastric balloons and 15 sutured gastroplasties (ESG-Apollo®). A non-invasive prospective analysis was performed via analytical (hepatic function, insulin-resistance and hepatic steatosis/fibrosis scores) and ultrasonographic parameters. In addition, anthropometric features and the evolution of the main obesity-related comorbidities were evaluated. The follow-up period was one year in all cases. RESULTS: thirty patients were included; 63% were female with a mean age of 46 ± 13.8 years. There was a decrease in FLI, HSI, NAFLD-Fibrosis Score, hepatic ultrasonographic steatosis, subcutaneous fat (p < 0.001), HOMA-IR, insulin and triglycerides (p < 0.05) after 12 months. An average EWL of 44.02% (16.34% TBWL) was obtained after one year, with EWL > 25% in 27/30 patients (TBWL > 10% in 25/30 patients) (p < 0.001). Obesity-related comorbidities were resolved in 17/30 (57%) of cases, 5/8 (62.5%) HTA, 5/12 (41.7%) DLP, 2/4 (50%) T2DM, 2/3 (66.7%) SOAS and 3/3 (100%) arthropathy. An improvement in HbA1c in the ESG-Apollo group (p = 0.017) was the only difference. One migrated and spontaneously expelled balloon was the only technical incidence. CONCLUSIONS: bariatric endoscopy could be proposed during short-term follow-up as an effective and safe alternative in patients with obesity and NAFLD. It stimulates weight loss and improves analytical and ultrasound parameters from hepatic fat, insulin-resistance and hypertriglyceridemia. It also improves associated major comorbidities.