Published online Jul 27, 2021. doi: 10.4254/wjh.v13.i7.815
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
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.
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.
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.
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.
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.
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.
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.