Improvements in hepatic steatosis, obesity, and insulin resistance in adults with nonalcoholic fatty liver disease after the primary obesity surgery endoluminal 2.0 procedure
Open accessAbstract
Background The primary obesity surgery endoluminal 2.0 (POSE 2.0) procedure involves full-thickness gastric body plications to narrow the stomach using durable suture anchor pairs. We evaluated POSE 2.0 as a treatment strategy for nonalcoholic fatty liver disease (NAFLD) in patients with obesity. Methods Adults with obesity and NAFLD were prospectively allocated based on their preference to undergo POSE 2.0 with lifestyle modification or lifestyle modification alone (control). Primary end points were improvement in controlled attenuation parameter (CAP) and resolution of hepatic steatosis at 12 months. Secondary end points included %total body weight loss (%TBWL), change in serum measures of hepatic steatosis and insulin resistance, and procedure safety. Results 42 adult patients were included (20 in the POSE 2.0 arm and 22 in the control arm). At 12 months, POSE 2.0 significantly improved CAP, whereas lifestyle modification alone did not (P < 0.001 for POSE 2.0; P = 0.24 for control). Similarly, both resolution of steatosis and %TBWL were significantly higher with POSE 2.0 than with control at 12 months. Compared with controls, POSE 2.0 significantly improved liver enzymes, hepatic steatosis index, and aspartate aminotransferase to platelet ratio at 12 months. There were no serious adverse events. Conclusion POSE 2.0 was effective for NAFLD in patients with obesity, with good durability and safety profile.
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POSE reduces HSI by 11.16 points.
“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 [88]
Table 2 (Laboratory outcomes) reports a 12-month HSI change of −11.16 points in the POSE 2.0 arm, supporting the stated reduction. The citing sentence gives P < 0.002, whereas the table reports P = 0.002 for the between-group comparison. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPOSE 2.0 significantly improves the hepatic steatosis index (HSI).
“Liver function markers, including the hepatic steatosis index (HSI) and aspartate aminotransferase to platelet ratio (APRI), also showed significant improvement.”
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 [88]
POSE 2.0 yields average total body weight loss of 18.0% at 6 months.
“POSE 2.0 patients experienced an average TBWL of 18.0% at 6 months and 17.5% at 12 months [88].”
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 [88]
31.6% of POSE 2.0 patients achieve complete steatosis resolution at 6 months.
“Notably, 31.6% of POSE 2.0 patients achieved complete steatosis resolution at 6 months, increasing to 52.6% at 12 months, while no improvements were observed in the control group.”
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 [88]
POSE 2.0 yields average total body weight loss of 17.5% at 12 months.
“POSE 2.0 patients experienced an average TBWL of 18.0% at 6 months and 17.5% at 12 months [88].”
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 [88]
52.6% of POSE 2.0 patients achieve complete steatosis resolution at 12 months.
“Notably, 31.6% of POSE 2.0 patients achieved complete steatosis resolution at 6 months, increasing to 52.6% at 12 months, while no improvements were observed in the control group.”
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 [88]
POSE 2.0 significantly improves the aspartate aminotransferase to platelet ratio (APRI).
“Liver function markers, including the hepatic steatosis index (HSI) and aspartate aminotransferase to platelet ratio (APRI), also showed significant improvement.”
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 [88]
No improvements in steatosis resolution were observed in the control group of the POSE 2.0 trial.
“Notably, 31.6% of POSE 2.0 patients achieved complete steatosis resolution at 6 months, increasing to 52.6% at 12 months, while no improvements were observed in the control group.”
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 [88]
POSE 2.0 significantly improves hepatic steatosis over 12 months compared to lifestyle modifications alone.
“A clinical trial involving 42 adults (20 POSE 2.0 and 22 control) found that POSE 2.0 significantly improved hepatic steatosis and liver enzyme levels over 12 months compared to lifestyle modifications alone [88].”
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 [88]
POSE 2.0 significantly improves liver enzyme levels over 12 months compared to lifestyle modifications alone.
“A clinical trial involving 42 adults (20 POSE 2.0 and 22 control) found that POSE 2.0 significantly improved hepatic steatosis and liver enzyme levels over 12 months compared to lifestyle modifications alone [88].”
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 [88]
POSE reduces CAP by 87 dB/m at 12 months.
“POSE showed the most significant improvement among endoscopic therapies, with an 87 dB/m drop at 12 months (p < 0.001) [88].”
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 [88]
POSE does not significantly change fibrosis.
“ESG showed gradual improvements [84], while POSE did not significantly change fibrosis [88].”
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 [88]
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- Authors
- AlKhatry, M., Rapaka, B., Maselli, D. B., Abboud, D. M., Brunaldi, V. O., Mahmoud, T., Ghazi, R., Abdul Razzak, F., Gala, K., Joudah, I., Housen, F., Al Qadi, S., Vargas, E. J., Storm, A. C., & Abu Dayyeh, B. K.
- Affiliations
- Ministry of Health (AE)
- Mayo Clinic (US)
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
- Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, Emirates Health Services, Ministry of Health, United Arab Emirates
- ORCID
- Venue
- Endoscopy
- Publisher
- Georg Thieme Verlag KG
- Published
- 2023-06-26
- Volume
- 55
- Issue
- 11
- Pages
- 1028-1034
- ISSN
- 0013-726X (ISSN-L)
- 1438-8812
- OpenAlex
- W4382049621
- Cited by
- 23
- References
- 20
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 8 · 2023: 2
- FWCI
- 4.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Endoscopy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- UAE Ministry of Health
- 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
- non-alcoholic fatty liver disease, obesity, suture anchors, hepatic steatosis, insulin resistance, weight loss, controlled attenuation parameter, liver enzymes, bariatric surgery
- MeSH terms
- Adult, Humans, Insulin Resistance, Life Style, Liver, Obesity, Non-alcoholic Fatty Liver Disease
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