Transforming MASH: The Power of ESG-Enhanced Lifestyle Interventions

KEY POINT:

Endoscopic sleeve gastroplasty (ESG) combined with lifestyle alterations results in considerable weight reduction and enhances liver function in individuals with metabolic dysfunction–associated steatohepatitis (MASH) and obesity over a span of 72 weeks.

APPROACH:

• A forward-looking randomized study was carried out across four centers in Spain from April 2018 to December 2020 to evaluate the efficacy and safety of ESG as a therapeutic option for MASH in adults with obesity (body mass index [BMI] ≥ 30).
• Participants presented stage 0-3 fibrosis, a histological nonalcoholic fatty liver disease (NAFLD) activity score of ≥ 3, and a score of ≥ 1 for both lobular inflammation and hepatocyte ballooning.
• Patients were randomly allocated to receive ESG, performed with an endoscopic suture system, or a sham endoscopy (SE), which consisted of a diagnostic upper endoscopy.
• Those in the ESG and SE groups adhered to a liquid diet for the initial 2 weeks preceding the procedure, followed by a shredded diet for the subsequent 2 weeks and a calorie-restricted diet of 1500 kcal for 2 months post-procedure, alongside lifestyle modifications such as a low-calorie Mediterranean diet, daily walking, and physical activity for the duration of the study.
• The main outcome was the resolution of MASH without deterioration of fibrosis during a 72-week follow-up period. Secondary outcomes included variations in body weight, liver fat, stiffness, fibrosis, and biochemical parameters.

SUMMARY:

• Researchers randomized 40 participants (median age: 56.5 years; average BMI: 37.85; 55% male), with 18 in the ESG group and 19 in the SE group completing the 72-week follow-up and receiving the final liver biopsy.
• The ESG group exhibited a body weight loss of 9.47% compared to 3.91% in the SE group, with a notable body weight reduction seen in 94.4% of patients in the ESG group versus 57.9% in the SE group.
• There was a notable decrease in liver stiffness by an average of 5.63 vs 0.2 kPa (P = .017) and in steatosis by an average of 0.94 vs 0.26 (P = .033) for ESG compared to SE.
• When compared to patients achieving < 10% weight loss, those with > 10% weight loss demonstrated a remarkable improvement in the NAFLD activity score (P < .001), steatosis (P < .001), lobular inflammation (P = .005), and ballooning (P < .001), with the resolution of MASH without any worsening of liver fibrosis occurring in 22.2% compared to 70% of patients (P = .007).
• ESG was successfully performed on all participants; however, two individuals faced serious adverse events necessitating hospitalization, which were managed conservatively within 72 hours.

IN APPLICATION:

“ESG should be considered as a second-line treatment option, with or without adjunctive weight loss therapies, particularly for patients unresponsive to lifestyle alterations,” the authors noted.

REFERENCES:

This research, directed by Javier Abad at Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

The outcomes of the study might have been affected by the limited pool of patients with significant fibrosis. Additionally, the unexpectedly high adherence to lifestyle changes in the SE group may have influenced the statistical significance of the findings.

DISCLOSURES:

This research received funding from the Carlos III Health Institute and the Ministry of Science and Innovation, Government of Spain. Several authors disclosed receiving grants, research support, consultancy and speaking fees, and/or involvement as speakers, consultants, and advisory board members for various pharmaceutical firms. One author mentioned serving as a proctor for Apollo Endosurgery.

This article was composed using multiple editorial tools, including AI, as part of the process. Human editors reviewed this content prior to publication.