Meta‐analysis: Impact of intragastric balloon therapy on NAFLD‐related parameters in patients with obesity

Summary Background Non‐alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease affecting approximately 25% of adults in the western world. Intragastric balloon (IGB) is an endoscopic bariatric therapy ‐a therapeutic endoscopic tool that has shown promise in inducing weight loss. Its role in the treatment of NAFLD is yet to be established. Aim To evaluate the effect of IGB as a treatment option in NAFLD. Methods We searched MEDLINE (PubMed) and EMBASE from inception to September 2022. We included studies evaluating the impact of IGB on obesity with the assessment of one or more liver‐related outcomes and studies primarily evaluating the impact of IGB on NAFLD. We included comparative and non‐comparative studies; primary outcomes were liver‐related NAFLD surrogates. Results We included 19 studies with 911 patients. IGB demonstrated an effect on NAFLD parameters including NAFLD activity score (NAS): mean difference (MD): −3.0 [95% CI: −2.41 to −3.59], ALT: MD: −10.40 U/L [95% CI: −7.31 to −13.49], liver volume: MD ‐397.9 [95% CI: −212.78 to 1008.58] and liver steatosis: MD: −37.76 dB/m [95% CI: −21.59 to −53.92]. There were significant reductions in non‐liver‐related outcomes of body weight, BMI, glycated haemoglobin and HOMA‐IR. Conclusion Intragastric balloons may play an important role in addressing the treatment gap in NAFLD management.