P4493 - No Clinically Significant Change in FIB-4 Score With ESG or Combined Therapy With ESG and Pharmacotherapy

Jeong Hoon Kim, MD¹, Jade Wang, MD¹, Enad Dawod, MD¹, Kamal Hassan, MD², Patrick Magahis, BA¹, Anam Rizvi, MD¹, Cynthia O. Akagbosu, MD, MA³, Mark Hanscom, MD¹, SriHari Mahadev, MD³, David L. Carr-Locke, MA, MD, FACG¹, Reem Sharaiha, MD¹, Kartik Sampath, MD^1
1Weill Cornell Medicine, New York, NY; ²New York-Presbyterian/Queens, New York, NY; ³New York-Presbyterian / Weill Cornell Medical Center, New York, NY

Introduction: Obesity is a major risk factor for metabolic syndrome, which itself is a risk factor for metabolic dysfunction-associated fatty liver disease (MAFLD) and its associated morbidity and mortality. The goal of endobariatric procedures such as endoscopic sleeve gastroplasty (ESG) and weight loss pharmacotherapies is to promote weight loss and decrease the risk of either the development or progression of MAFLD. The Fibrosis-4 (FIB-4) score is a clinical tool used to calculate the risk of liver fibrosis in patients undergoing ESG. This study investigated whether significant change in FIB-4 score occurs post-procedure either after ESG alone or ESG combined with sequential weight-loss pharmacotherapy.

Methods: A single-center retrospective study was performed for all patients who underwent ESG at a large academic tertiary care center from June 2021 to September 2023. Demographic data and pharmacotherapy use were recorded. FIB-4 scores were calculated from laboratory data prior to ESG and from most recent post-ESG laboratory data. Pharmacotherapy included semaglutide, phentermine with or without topiramate, bupropion with or without naltrexone, orlistat, liraglutide, metformin, and topiramate alone.

Results: Of the 136 patients who underwent ESG during the study period, 53 did not have relevant laboratory values recorded and were excluded from analysis given FIB-4 scores could not be calculated. Demographic data (ESG alone, ESG with pharmacotherapy) included average age in years (42, 43), female gender (96%, 86%), pre-ESG weight in pounds (208, 214) and BMI (35.7, 36.8). There was no significant difference in pre-ESG or post-ESG FIB-4 scores between the 2 groups. On average, FIB-4 scores increased post-ESG by 0.06 in the ESG alone group and by 0.03 in the ESG/pharmacotherapy group; however, the difference was not statistically significant (Table 1).

Discussion: Our results showed that in both patients who underwent ESG alone and ESG combined with sequential pharmacotherapy, FIB-4 scores tended to increase a small amount post-ESG, but there was no significant difference between groups. This increase (< 0.1 in both groups) is unlikely to be clinically significant. It is likely that regression of hepatic injury takes a longer time to manifest than the one-year span studied here. Further studies on the relationship between post-ESG weight loss and liver fibrosis will be necessary to determine whether ESG has the ability to deter progression of liver fibrosis.


Disclosures:


Jeong Hoon Kim, MD¹, Jade Wang, MD¹, Enad Dawod, MD¹, Kamal Hassan, MD², Patrick Magahis, BA¹, Anam Rizvi, MD¹, Cynthia O. Akagbosu, MD, MA³, Mark Hanscom, MD¹, SriHari Mahadev, MD³, David L. Carr-Locke, MA, MD, FACG¹, Reem Sharaiha, MD¹, Kartik Sampath, MD¹. P4493 - No Clinically Significant Change in FIB-4 Score With ESG or Combined Therapy With ESG and Pharmacotherapy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.