DataSheet_1_Effects of Bariatric Endoscopy on Non-Alcoholic Fatty Liver Disease: A Comprehensive Systematic Review and Meta-Analysis.docx

Background and objectiveEndoscopic bariatric and metabolic therapies (EBMTs) are emerging minimally invasive therapeutic options for obesity and its related complications, including non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the effects of EBMTs on NALFD in patients with obesity.
MethodsFour databases were searched until Nov 2021. Randomized controlled trials (RCTs) and observational studies reporting liver-related outcomes following Food and Drug Administration (FDA)-approved and non-FDA-approved EBMTs were included. Liver parameters, metabolic parameters, and weight loss were evaluated. Risk of bias was assessed using the “risk of bias” tool in the Cochrane Collaboration for RCTs and the Methodological Index for Non-Randomized Studies criteria for observational studies.
ResultsThirty-three studies with 1710 individuals were included. Regarding the effects of EBMTs on liver fibrosis, a significant decline of NAFLD Fibrosis Score, but not transient elastography-detected liver stiffness or Fibrosis-4 Index, was observed. EBMTs significantly improved liver steatosis (control attenuation parameter and Hepatic Steatosis Index), NAFLD Activity Score, and Homeostasis Model Assessment of Insulin Resistance. EBMTs reduced serum levels of alanine transaminase, aspartate aminotransferase, and gamma-glutamyl transpeptidase considerably. Moreover, EBMTs had reducing effects on the serum levels of triglycerides and total cholesterol as well as body weight.
ConclusionsOur meta-analysis suggested that EBMTs could ameliorate NAFLD based on the evidence of improved liver steatosis, liver function, and insulin resistance. Large-scale, prospective, long-term studies are warranted to clarify the role of EBMTs in patients with different stages of NAFLD.

背景与目的
内镜下减重代谢疗法（Endoscopic bariatric and metabolic therapies, EBMTs）是针对肥胖及其相关并发症（包括非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD））的新兴微创治疗手段。本研究旨在评估EBMTs对肥胖患者NAFLD的治疗效果。

方法
本研究检索了截至2021年11月的4个数据库，纳入经美国食品药品监督管理局（Food and Drug Administration, FDA）批准及未获批的EBMTs治疗后报告肝脏相关结局的随机对照试验（randomized controlled trials, RCTs）与观察性研究。评估指标包括肝脏参数、代谢参数及体重变化。对于RCTs，采用科克伦协作网的“偏倚风险”工具评估偏倚风险；对于观察性研究，则采用非随机研究方法学指数标准进行偏倚风险评价。

结果
本研究共纳入33项研究，涉及1710名受试者。关于EBMTs对肝纤维化的影响，研究观察到NAFLD纤维化评分显著降低，但瞬时弹性成像检测的肝脏硬度值及肝纤维化4指数无明显变化。EBMTs可显著改善肝脏脂肪变性（受控衰减参数及肝脏脂肪变性指数）、NAFLD活动度评分以及胰岛素抵抗稳态模型评估指数。EBMTs可显著降低血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶及γ-谷氨酰转移酶水平。此外，EBMTs还可降低血清甘油三酯、总胆固醇水平及体重。

结论
本项荟萃分析表明，基于肝脏脂肪变性、肝功能及胰岛素抵抗得到改善的证据，EBMTs可改善NAFLD。未来仍需开展大规模、前瞻性、长期的研究，以明确EBMTs在不同分期NAFLD患者中的应用价值。