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

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

World J Hepatol. 2021 Jul 27;13(7):815-829. doi: 10.4254/wjh.v13.i7.815.

Authors

Affiliations

¹ Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
² Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR. igorbraga1@gmail.com.
³ 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.
⁴ Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil.

Abstract

Background: Metabolic dysfunction-associated fatty liver disease corresponds to a clinical entity that affects liver function triggered by the accumulation of fat in the liver and is linked with metabolic dysregulation.

Aim: To evaluate the effects of the intragastric balloon (IGB) in patients with metabolic dysfunction-associated fatty liver disease through the assessment of liver enzymes, imaging and several metabolic markers.

Methods: A comprehensive search was done of multiple electronic databases (MEDLINE, EMBASE, LILACS, Cochrane and Google Scholar) and grey literature from their inception until February 2021. Inclusion criteria involved patients with a body mass index > 25 kg/m² with evidence or previous diagnosis of hepatic steatosis. 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).

Results: Ten retrospective cohort studies evaluating a total of 508 patients were included. After 6 mo of IGB placement, this significantly reduced alanine aminotransferase [mean difference (MD): 10.2, 95% confidence interval (CI): 8.12-12.3], gamma-glutamyltransferase (MD: 9.41, 95%CI: 6.94-11.88), glycated hemoglobin (MD: 0.17%, 95%CI: 0.03-0.31), triglycerides (MD: 38.58, 95%CI: 26.65-50.51), systolic pressure (MD: 7.27, 95%CI: 4.79-9.76), homeostatic model assessment (MD: 2.23%, 95%CI: 1.41-3.04), abdominal circumference (MD: 12.12, 95%CI: 9.82-14.41) and body mass index (MD: 5.07, 95%CI: 4.21-5.94).

Conclusion: IGB placement showed significant efficacy in improving alanine aminotransferase and gamma-glutamyltransferase levels in patients with metabolic dysfunction-associated fatty liver disease as well as improving metabolic markers related to disease progression.

Keywords: Abdominal circumference; Body mass index; Homeostatic model assessment; Intragastric balloon; Metabolic dysfunction-associated fatty liver disease.