Endoscopic sleeve gastroplasty — minimally invasive treatment for non-alcoholic fatty liver disease and obesity
Abstract
Introduction Adequate weight loss can lead to reduction in steatosis, inflammation, and fibrosis in patients with obesity and non-alcoholic fatty liver disease (NAFLD). We evaluated the role of endoscopic sleeve gastroplasty (ESG) in patients with obesity and NAFLD. Methods In this single-center prospective study, consecutive adult patients with NAFLD who underwent ESG between November 2018 and May 2019 were included. The primary outcome was the impact of ESG on hepatic parameters: change in alanine aminotransferase (ALT), hepatic steatosis index (HSI), NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4), and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) from baseline to 6 and 12 months. Secondary outcomes included change in glycated hemoglobin (HbA1c), percentage weight loss, and safety. Analysis of variance with repeated measures was used for statistical analysis. Results A total of 26 patients (mean age [SD] 41.5 [9.58] years; 16 females) with mean (SD) weight of 99.43 (21.89) kg at baseline were included. There was significant improvement in ALT (mean ± SD) from baseline of 59.54 ± 17.02 IU/L to 49.50 ± 11.72 IU/L and 48.42 ± 13.22 IU/L at 6 and 12 months (p = 0.001). Mean (SD) NFS was significantly improved from 0.228 (1.00) at baseline to -0.202 (1.16) and -0.552 (1.08) at 6 and 12 months (p 0.001). Mean (SD) HSI, FIB-4, and APRI scores significantly reduced from baseline to 6 and 12 months (p = 0.001). There was 18.07% total body weight loss at 12 months, with significant improvement in HbA1c. There were no major adverse events. Conclusion ESG is a safe and effective treatment option for patients with NAFLD and obesity causing significant weight loss. Rigorous randomized trials are required to incorporate ESG in NAFLD treatment algorithm.
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ESG reduces NAFLD fibrosis score at 6 and 12 months post-procedure.
“A 26-patient study confirmed reductions in ALT, hepatic steatosis index, and NAFLD fibrosis score at 6 and 12 months post-procedure [83].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [83]
ESG reduces hepatic steatosis index at 6 and 12 months post-procedure.
“A 26-patient study confirmed reductions in ALT, hepatic steatosis index, and NAFLD fibrosis score at 6 and 12 months post-procedure [83].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [83]
ESG reduces ALT at 6 and 12 months post-procedure in a 26-patient study.
“A 26-patient study confirmed reductions in ALT, hepatic steatosis index, and NAFLD fibrosis score at 6 and 12 months post-procedure [83].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [83]
ESG reduces ALT by 16%.
“Other procedures showed variable ALT reductions: IGB (20.3–38%) [74,76], DMR (29.3%) [94], and ESG (16%) [83].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [83]
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- Authors
- Jagtap, N., Kalapala, R., Katakwar, A., Sharma, M., Aslam, M., Gupta, R., Rao, P. N., Goud, R., Tandan, M., Kanakagiri, H., Darishetty, S., & Reddy, D. N.
- Affiliations
- Asian Institute of Gastroenterology (IN)
- Corresponding author
- Jagtap, Nitin
- ORCID
- Venue
- Indian Journal of Gastroenterology
- Published
- 2021-12
- Volume
- 40
- Issue
- 6
- Pages
- 572-579
- ISSN
- 0254-8860 (ISSN-L)
- 0975-0711
- OpenAlex
- W4200571306
- Cited by
- 43
- References
- 37
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 7 · 2023: 10 · 2022: 3 · 2021: 1
- FWCI
- 3.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Indian Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- endoscopic sleeve gastroplasty, non-alcoholic fatty liver disease, obesity, weight loss, hepatic steatosis, liver fibrosis, alanine aminotransferase, NAFLD fibrosis score, FIB-4, APRI, HbA1c, minimally invasive treatment, inflammation reduction
- MeSH terms
- Adult, Female, Fibrosis, Glycated Hemoglobin, Humans, Male, Middle Aged, Obesity, Prospective Studies, Gastroplasty, Weight Loss, Treatment Outcome, Non-alcoholic Fatty Liver Disease
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