Endoscopic bariatric and metabolic therapies for non-alcoholic fatty liver disease: Evidence and perspectives

Liver Int. 2020 Jun;40(6):1262-1268. doi: 10.1111/liv.14441. Epub 2020 Apr 6.


Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease in industrialized countries because of the worldwide epidemic of obesity. Beyond metabolic complications, a subset of patients with NAFLD develop non-alcoholic steatohepatitis (NASH) with fibrosis, which is emerging as a leading cause of liver transplantation due to progression to cirrhosis and cancer. For these reasons, NAFLD is considered a public health burden. In recent years endoscopic bariatric and metabolic therapies (EBMT) have emerged as safe and effective for the treatment of obesity and type 2 diabetes mellitus. EBMT include gastric and duodenal devices and techniques such as intragastric balloons, endoscopic sleeve gastroplasty, endoscopic small bowel by-pass and duodenal mucosal resurfacing. Observational studies and pilot trials have revealed beneficial effects of EBMT on NAFLD as assessed by non-invasive parameters or histology. In this review we summarise current evidence for the efficacy and safety of EBMT in obese patients with NAFLD and examine future clinical applications.

Keywords: NAFLD; bariatric endoscopy; duodenal mucosal resurfacing; endoscopic sleeve gastroplasty; intragastric balloon; obesity.

Publication types

  • Review

MeSH terms

  • Bariatrics*
  • Diabetes Mellitus, Type 2* / complications
  • Humans
  • Liver Cirrhosis
  • Non-alcoholic Fatty Liver Disease* / therapy
  • Obesity / complications