P4585 - A Systematic Review and Network Meta-Analysis of Endoscopic Innovations in MASLD Management

Raj H. Patel, MD¹, Charmy Parikh, MD², Dev Desai, MBBS³, Maurya Patel, MBBS⁴, Yug Patel, MBBS⁵, Truptesh Kothari, MD^6
1St. Mary Medical Center, Bensalem, PA; ²Mercy Catholic Medical Center, Darby, PA; ³Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ⁴Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India; ⁵Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India; ⁶University of Rochester Medical Center, Rochester, NY

Introduction: In recent years, MASLD has evolved as one of the leading causes of liver cirrhosis in western countries. Obesity and metabolic syndrome are common predisposing factors for MASLD patients. Various studies have proven reduction in obesity leads to better MASLD outcomes. Recently endobariatrics have emerged as one of the leading interventions for weight loss, and an increasing number of studies have reported positive effects of endobariatric techniques on MASLD. In our study, we aim to examine the comparative effectiveness of these interventions on hospitalized MASLD patients.

Methods: A systematic review and network meta-analysis was conducted following a systematic search across various database using relevant keywords yielding 18 articles involving 953 patients with consideration of inclusion/exclusion criteria, Prisma Guidelines and bias assessments. In the Intervention group, we included DJBS, DMR, ESG, IGB, and lifestyle modifications compared to baseline measures. Key outcomes included HOMA-IR values and ALT levels. RevMan 5.3 was used for analysis with employment of Fixed and Random Effect Model tests with statistical significance set at p< 0.05. For interventions lacking direct comparator groups, we relied on indirect comparisons against other modalities. To facilitate this, League Tables and Mean Rank Tables were generated post-standardization of controls.

Results: Among the five experimental groups examined, IGB demonstrated the most effective reduction in HOMA-IR, showing a pooled mean difference (MD) of -2.82 (95% CI: -4.66 to -0.97). When comparing within the experimental groups, IGB ranked highest with a mean rank of 1, indicating superior performance compared to Lifestyle modifications, which ranked fifth with a MD of -2.137. ESG showed the greatest improvement in ALT values, although not statistically significant, with an MD of -22 (95% CI: -54.99 to 10.99). DMR had an MD of -10.16, while IGB also demonstrated a significant decrease of -9.97 (95% CI: -14.42 to -5.52) in ALT values. Our systematic review yielded studies that reported MRI-PDFF, HSI, NFS as well as various biopsy scores.Significant reduction in steatosis and steatohepatitis was noted in various surgical studies but given lack of common variables we couldn’t compare that with endoscopic modalities.

Discussion: In conclusion, our study provides valuable insights into the differential effects of EBMTs on MASLD markers, offering practical implications for optimizing treatment approaches in MASLD.



Disclosures:


Raj H. Patel, MD¹, Charmy Parikh, MD², Dev Desai, MBBS³, Maurya Patel, MBBS⁴, Yug Patel, MBBS⁵, Truptesh Kothari, MD⁶. P4585 - A Systematic Review and Network Meta-Analysis of Endoscopic Innovations in MASLD Management, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.