de Freitas Júnior JR, Ribeiro IB, de Moura DTH, Sagae VMT, de Souza GMV, de Oliveira GHP, Sánchez-Luna SA, de Souza TF, de Moura ETH, de Oliveira CPMS, Bernardo WM, de Moura EGH. Effects of intragastric balloon placement in metabolic dysfunction-associated fatty liver disease: A systematic review and meta-analysis. World J Hepatol 2021; 13(7): 815-829 [PMID: 34367502 DOI: 10.4254/wjh.v13.i7.815]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Hepatol. Jul 27, 2021; 13(7): 815-829 Published online Jul 27, 2021. doi: 10.4254/wjh.v13.i7.815
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 Processing time: 158 Days and 16.8 Hours
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.
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.
