A recent study presented at the EASL Congress has found that endoscopic sleeve gastroplasty (ESG) is more effective for weight loss in patients with both nonalcoholic steatohepatitis (NASH) and obesity, compared to lifestyle modification alone. Previous studies have shown that lifestyle intervention can lead to NASH resolution and fibrosis regression, but less than 10% of patients achieve significant weight loss through diet and exercise alone. In recent years, endoscopic bariatric and metabolic therapies, including ESG, have emerged as safe and effective options for promoting weight loss in obese patients. However, the current evidence on ESG in NASH patients is limited. To evaluate the safety and efficacy of ESG in NASH patients, researchers conducted a multicenter, randomized, double-blind study on 40 patients with NASH and obesity. The patients were divided into two groups: one receiving ESG with lifestyle modification and the other receiving endoscopic simulated intervention (ESI) with lifestyle modification. The study measured changes in the laboratory, elastography, and histological parameters between the two groups. The results showed that 94.4% of patients in the ESG group experienced a significant reduction in body weight, with an average loss of 11.03 kg (9.57% body weight loss). In contrast, only 57.9% of patients in the ESI group lost weight, with an average loss of 3.85 kg (3.91% body weight loss). Additionally, 22% of patients in the ESG group achieved a weight loss of more than 15%. Furthermore, patients in the ESG group demonstrated significant improvement in liver function markers and liver stiffness compared to those in the ESI group. Patients who achieved a weight loss of more than 10% also experienced a significant improvement in NASH score and its components, with a 70% resolution of NASH.

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