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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Effects of intragastric balloon placement in metabolic dysfunction-associated fatty liver disease: A systematic review and meta-analysis
João Remí de Freitas Júnior, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Vitor Massaro Takamatsu Sagae, Gabriel Mayo Vieira de Souza, Guilherme Henrique Peixoto de Oliveira, Sergio A Sánchez-Luna, Thiago Ferreira de Souza, Eduardo Turiani Hourneaux de Moura, Cláudia Pinto Marques Souza de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
João Remí de Freitas Júnior, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Vitor Massaro Takamatsu Sagae, Gabriel Mayo Vieira de Souza, Guilherme Henrique Peixoto de Oliveira, Thiago Ferreira de Souza, Eduardo Turiani Hourneaux de Moura, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
Sergio A Sánchez-Luna, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham, Birmingham, AL 35294, United States
Cláudia Pinto Marques Souza de Oliveira, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
Author contributions: de Freitas Júnior JR and Ribeiro IB conducted data collection; de Moura DTH, Sagae VMT, de Souza GMV and de Oliveira GHP conducted data analysis and interpretation, revised the article and finally approved; Sánchez-Luna SA and de Moura ETH conducted data analysis and interpretation and revision of the article; Freitas Junior JR, Ribeiro IB, de Souza TF and de Moura EGH were responsible for analyzing and interpreting the data, drafting the article, revising the article and finally approving; de Oliveira CPMS and Bernardo WM conducted data analysis and interpretation and drafted the article .
Conflict-of-interest statement: Dr. Moura reports personal fees from Boston Scientific, personal fees from Olympus, outside the submitted work.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Igor Braga Ribeiro, MD, Doctor, Research Fellow, Surgeon, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, São Paulo 05403-010, Brazil. igorbraga1@gmail.com
Received: February 14, 2021
Peer-review started: February 14, 2021
First decision: April 6, 2021
Revised: April 12, 2021
Accepted: July 2, 2021
Article in press: July 2, 2021
Published online: July 27, 2021
ARTICLE HIGHLIGHTS
Research background
Endoscopy has improved and has become the treatment of several diseases in recent decades. Bariatric endoscopy, through its various devices, helps in the treatment of obesity and its complications. Thus, the intragastric balloon (IGB) proves to be an effective and safe therapy for coping with this disease, and its indications have increased.
Research motivation
Metabolic dysfunction-associated fatty liver disease (MAFLD) corresponds to the accumulation of fat in the liver linked with metabolic dysregulation and has a high prevalence rate among the population. Unfortunately, no pharmacological therapy has yet shown efficacy in its treatment. In this sense, there is a need for new therapies to treat this new global epidemic.
Research objectives
We aimed to evaluate the effect of IGB in patients with MAFLD through the assessment of liver enzymes, imaging and metabolic markers in a systematic review of literature and meta-analysis.
Research methods
This systematic review was conducted according to the PRISMA guidelines and registered in PROSPERO international database. The search was performed in the electronic databases (MEDLINE, Embase, Cochrane, LILACS) and grey literature. The quality of evidence was assessed utilizing criteria from Grading Recommendations Assessment, Development, and Evaluation. The risk of bias was assessed by the Risk of Bias in Non-randomized Studies-of Interventions tool and the data were meta-analyzed using the RevMan software (Review Manager Software version 5.4-Cochrane Collaboration Copyright© 2020) using the inverse variance test.
Research results
Ten studies (non-randomized studies-of interventions) with 508 patients were meta-analyzed from an initial search of 1674 articles. The outcomes analyzed before and after 6 mo of IGB removal were alanine aminotransferase (IU/L), gamma-glutamyltransferase (IU/L), glycated hemoglobin (%), triglycerides (mg/dL), systolic blood pressure (mmHg), homeostatic model assessment, abdominal circumference (cm), body mass index (kg/m2) and liver volume (cm3). After 6 mo of use, the IGB showed an improvement in alanine aminotransferase, gamma-glutamyltransferase, glycated hemoglobin, triglycerides, systolic blood pressure, homeostatic model assessment, abdominal circumference and body mass index. The liver volume analysis showed a non-statistically significant reduction.
Research conclusions
Our findings suggest that IGB had a significant improvement in liver enzymes (alanine aminotransferase and gamma-glutamyltransferase) in patients with MAFLD as well as improved metabolic biomarkers related to disease progression.
Research perspectives
Future studies should assess prolonged follow-up of patients after the intervention to analyze the long-term response to the improvements observed in the initial studies. A histological analysis using liver biopsies seems to be the best method of analyzing the effects of the IGB on the progression of MAFLD, and further studies should consider this method of evaluation.
