Gastrointestinal endoscopy · 2026
Endoscopic gastric remodeling and its histologic impact on metabolic dysfunction-associated steatohepatitis: a 12-month prospective study.
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Jirapinyo Pichamol, Papke David J, Garcia-Tsao Guadalupe, Ryou Marvin, Zhao Lei, Zucker Stephen D, Thompson Christopher C
Аннотация
BACKGROUND AND AIMS: Weight loss through lifestyle modification or glucagon-like peptide-1 receptor agonists (GLP-1RAs) is first-line therapy for metabolic dysfunction-associated steatohepatitis (MASH). However, few subjects achieve sufficient weight loss with lifestyle changes, and long-term medication use limits GLP-1RA adoption. This study evaluated the effect of endoscopic gastric remodeling (EGR), a 1-time, minimally invasive intervention, on MASH histologic features.
METHODS: In this 12-month prospective study, subjects with obesity and biopsy-proven MASH with fibrosis underwent EGR using the U.S. Food and Drug Administration-cleared endoscopic plication device. Baseline and follow-up assessments included EUS-guided liver biopsy and portosystemic pressure gradient measurement.
RESULTS: Twenty subjects underwent EGR; 13 completed 12-month follow-up. Median weight decreased by 16.5%, with 73% achieving ≥10% total weight loss. MASH resolution occurred in 46%, fibrosis improvement in 54%, and nonalcoholic fatty liver disease Activity Score improved in 85%, with significant reductions in portosystemic pressure gradient. No serious adverse events occurred.
CONCLUSIONS: EGR improves histologic MASH and fibrosis and represents a promising minimally invasive therapy.
METHODS: In this 12-month prospective study, subjects with obesity and biopsy-proven MASH with fibrosis underwent EGR using the U.S. Food and Drug Administration-cleared endoscopic plication device. Baseline and follow-up assessments included EUS-guided liver biopsy and portosystemic pressure gradient measurement.
RESULTS: Twenty subjects underwent EGR; 13 completed 12-month follow-up. Median weight decreased by 16.5%, with 73% achieving ≥10% total weight loss. MASH resolution occurred in 46%, fibrosis improvement in 54%, and nonalcoholic fatty liver disease Activity Score improved in 85%, with significant reductions in portosystemic pressure gradient. No serious adverse events occurred.
CONCLUSIONS: EGR improves histologic MASH and fibrosis and represents a promising minimally invasive therapy.