Effects of intragastric balloon placement in metabolic dysfunction-associated fatty liver disease: A systematic review and meta-analysis

Table 2 Grading recommendations assessment, development and evaluation certainty evidence assessment table

	Certainty evidence assessment							Study event rates (%)
	Participants (studies) follow up	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Overall certainty of evidence	With post-IGB	With pre-IGB	Risk difference with Pre-IGB
ALT	1114 (10 observational studies)	Not serious	Serious1	Not serious2	Not serious	Publication bias strongly suspected3	⨁⨁◯◯, Low	557	557	Mean 10.27 UI/L more (8.25 more to 12.29 more)
GGT	1014 (8 observational studies)	Not serious	Not serious	Not serious2	Not serious	None	⨁⨁⨁⨁, High	507	507	Mean 9.23 UI/L more (6.88 more to 11.58 more)
Hb1Ac	300 (6 observational studies)	Not serious	Not serious	Not serious4	Not serious	Publication bias strongly suspected3	⨁⨁⨁◯, Moderate	150	150	Mean 0.17 % higher (0.03 higher to 0.31 higher)
Triglycerides	564 (6 observational studies)	Not serious	Not serious	Not serious	Not serious	None	⨁⨁⨁⨁, High	282	282	Mean 38.58 mg/dL higher (26.65 higher to 50.51 higher)
Systolic blood pressure	468 (3 observational studies)	Not serious	Not serious	Not serious	Not serious	None	⨁⨁⨁⨁, High	234	234	Mean 7.27 mmHg higher (4.79 higher to 9.76 higher)
HOMA-IR	378 (5 observational studies)	Not serious	Serious1	Not serious	Not serious	None	⨁⨁⨁◯, Moderate	189	189	Mean 2.07 higher (1.64 higher to 2.49 higher)
BMI	912 (8 observational studies)	Not serious	Not serious	Not serious	Not serious	Strong association	⨁⨁⨁⨁, High	456	456	Mean 5.07 kg/m2 higher (4.21 higher to 5.94 higher)
Waist	672 (7 observational studies)	Not serious	Not serious	Not serious	Not serious	None	⨁⨁⨁⨁, High	336	336	Mean 12.12 cm higher (9.82 higher to 14.41 higher)
Liver volume	32 (2 observational studies)	Not serious	Not serious	Not serious	Serious5	None	⨁⨁⨁◯, Moderate	16	16	MD 303.24 higher (56.66 lower to 663.15 higher)

¹Heterogeneity > 50%.

²Indirect measurement of hepatic steatosis.

³Presence of Outlier.

⁴Surrogate endpoint.

⁵Wide confidence interval. Overall certainty of evidence definition: ⨁◯◯◯: Very low-Any estimate of effect is very uncertain; ⨁⨁◯◯: Low-Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; ⨁⨁⨁◯: Moderate-Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; ⨁⨁⨁⨁: High-Further research is very unlikely to change our confidence in the estimate of effect; MD: Mean difference; IGB: Intragastric balloon; HbA1c: Glycated hemoglobin; ALT: Alanine aminotransferase; GGT: Gamma-glutamyltransferase; HOMA-IR: Homeostatic model; BMI: Body mass index.