Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty
Abstract
Background and aims Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States and is closely associated with obesity and insulin resistance (IR). Weight loss is the best treatment for NAFLD. Endoscopic sleeve gastroplasty (ESG) is a promising endoscopic procedure for treatment of obesity. Our aim is to evaluate the change in IR and estimated hepatic steatosis and fibrosis after ESG. Methods One hundred eighteen patients with obesity and NAFLD underwent ESG and were followed for 2 years. Weight loss was evaluated as % total body weight loss. IR was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). The previously validated hepatic steatosis index and NAFLD fibrosis score were used to estimate hepatic steatosis and risk of fibrosis. Results Patients' mean body mass index was 40 ± 7 kg/m 2 at baseline. Eighty-four percent of patients completed 2 years of follow-up. At 2 years, the mean total body weight loss was 15.5% (95% confidence interval, 13.3%-17.8%). Patients' HOMA-IR improved significantly from 6.7 ± 11 to 3.0 ± 1.6 after only 1 week from ESG (P = .019) with continued improvement up to 2 years (P = .03). Patients' hepatic steatosis index score improved significantly, decreasing by 4 points per year (P for trend, <.001). Patients' NAFLD fibrosis score improved significantly, decreasing by 0.3 point per year (P for trend, .034). Twenty-four patients (20%) improved their risk of hepatic fibrosis from F3-F4 or indeterminate to F0-F2, whereas only 1 patient (1%) experienced an increase in the estimated risk of fibrosis (P = .02). Conclusions Our results suggest a significant and sustained improvement in estimated hepatic steatosis and fibrosis after ESG in patients with NAFLD. Importantly, we showed an early and weight-independent improvement in insulin resistance, which lasted for 2 years after the procedure.
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20% of patients with advanced fibrosis (F3-F4) improve to lower fibrosis stages (F0-F2) after ESG.
“Additionally, 20% of participants with advanced fibrosis (F3–F4) improved to lower fibrosis stages (F0–F2) after ESG [85].”
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 [85]
ESG reduces NAFLD fibrosis score by 0.3 points per year in a longitudinal study.
“A longitudinal study found that patients maintained reductions in NAFLD fibrosis score and hepatic steatosis index, decreasing by 0.3 and 4 points per year, respectively [85].”
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 [85]
ESG reduces hepatic steatosis index by 4 points per year in a longitudinal study.
“A longitudinal study found that patients maintained reductions in NAFLD fibrosis score and hepatic steatosis index, decreasing by 0.3 and 4 points per year, respectively [85].”
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 [85]
ESG reduces HSI by 4-4.85 points at one year.
“Hepatic steatosis index (HSI): EndoBarrier reduced HSI by five points at 9 months (p < 0.001) [100], POSE by 11.16 points (p < 0.002) [88], and ESG by 4–4.85 points at one year [82,85].”
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 [85]
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- Authors
- Hajifathalian, K., Mehta, A., Ang, B., Skaf, D., Shah, S. L., Saumoy, M., Dawod, Q., Dawod, E., Shukla, A., Aronne, L., Brown, R. S., Cohen, D. E., Dannenberg, A. J., Fortune, B., Kumar, S., & Sharaiha, R. Z.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Cornell University (US)
- University of Pennsylvania (US)
- Corresponding author
- Sharaiha, Reem Z.
- ORCID
- Venue
- Gastrointestinal Endoscopy
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 93
- Issue
- 5
- Pages
- 1110-1118
- ISSN
- 0016-5107 (ISSN-L)
- OpenAlex
- W3081087626
- Cited by
- 96
- References
- 7
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 23 · 2023: 20 · 2022: 17 · 2021: 11
- FWCI
- 8.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastrointestinal Endoscopy (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, insulin resistance, hepatic steatosis, liver fibrosis, obesity, weight loss, HOMA-IR, hepatic steatosis index, NAFLD fibrosis score
- MeSH terms
- Fibrosis, Humans, Insulin Resistance, Liver Cirrhosis, Prospective Studies, Gastroplasty, Non-alcoholic Fatty Liver Disease
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