The effect of endoscopic gastric plication on portosystemic pressure gradient in patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease

Abstract

Background and Aims: Goals of therapy for patients with nonalcoholic fatty liver disease (NAFLD) and compensated advanced chronic liver disease (cACLD) include weight loss and reduction of the portosystemic pressure gradient (PPG) to decrease the risk of hepatic decompensation. Endoscopic gastric plication (EGP) is an effective endoscopic weight loss procedure. This study aims to assess the effect of EGP on PPG. Patients and Methods: In this prospective pilot study, patients with NAFLD and cACLD underwent endoscopic ultrasound-guided PPG determination prior to and at 6 months following EGP. Primary outcomes were the change in PPG and proportion of patients experiencing ≥20% reduction in PPG at 6 months. Secondary outcomes included weight loss and changes in non-invasive tests (NITs) of fibrosis. Results: 20 subjects were included. Baseline BMI and liver stiffness measurement were 40.2 [30.1-56.7] kg/m2 and 14.7 [8.2-36] kPa. At 6 months, PPG decreased from 5.4 [0.7-19.6] mmHg to 1.8 [0.4-17.6] mmHg (p=0.002), with 79% (11 out of 14) experiencing ≥20% reduction. Subjects experienced 12.5 [6.5-26.1]% TWL (p = 0.0001) at 6 months, with 89% (17 out of 19) achieving ≥7% and 68% (13 out of 19) achieving ≥10% TWL. There were significant improvements in NITs of fibrosis. Conclusion: Endoscopic gastric plication appears effective at reducing PPG in patients with NAFLD and cACLD.