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Endoscopic intragastric balloon improved NASH parameters
Key clinical point: Intragastric balloon placement was associated with histologic and metabolic improvements in patients with nonalcoholic steatohepatitis.
Major finding: At 6 months, nonalcoholic fatty liver disease activity scores had improved in 18 of 20 biopsied patients (90%), with a median decrease of 3 points.
Study details: A prospective study of 21 patients with nonalcoholic steatohepatitis and early hepatic fibrosis.
Disclosures: Apollo Endosurgery provided intragastric balloons, and Medtronic provided SharkCore needles. The senior author and two coinvestigators disclosed ties to Apollo Endosurgery, Medtronic, Metamodix, Boston Scientific, Cairn Diagnostics, Aspire Bariatrics, Johnson and Johnson, AstraZeneca, Genfit, Gila Therapeutics, and several other companies. The other investigators reported having no conflicts of interest.
Bazerbachi F et al. Clin Gastroenterol Hepatol. 2020 Apr 30. doi: 10.1016/j.cgh.2020.04.068.
Obesity a well-known risk factor for the development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis, the latter of which is expected to become the leading indication for liver transplantation. As such addressing the steatosis in these patients is critical. A drop of even 5%-10% of total body weight with diet and exercise can result in significant improvement in liver disease.
Unfortunately, achieving this weight loss is challenging. For the appropriate candidate, bariatric surgery offers the most effective and durable route to weight loss. However, not all patients qualify, and uptake of surgery in appropriate candidates remains low. As such, other treatment options are needed. Endoscopic bariatric therapies, including intragastric balloons, are one such treatment option that may provide significant improvement in hepatic steatosis. However data to support this remain limited.
In this article, Dr. Bazerbachi and colleagues work to advance the case for intragastric balloons as a successful treatment option for NAFLD. They performed a prospective, open-label study on 21 patients treated with an intragastric balloon for 6 months. Using gold-standard histology and noninvasive magnetic resonance elastography before and after therapy, they show significant improvement in NAFLD activity score (median change, 3 points; range, 1-4) over a short duration of treatment. Interestingly, the collection of the liver biopsy sample is done via endoscopic ultrasound, which can be easily performed during placement and removal of this intragastric balloon. While promising, follow-up studies are needed to show sustained improvement in NAFLD after the balloon is removed.
Wasif M. Abidi, MD, PhD, is assistant professor of medicine, gastroenterology, Baylor College of Medicine, Houston.