Endoscopic sleeve gastroplasty (ESG) has emerged as a promising non-surgical alternative for weight loss and liver health improvement, significantly outperforming sham endoscopy in reducing body weight (–9.47% vs. –3.91%) and improving liver stiffness and steatosis. While ESG effectively enhanced NAFLD activity scores, its impact on fibrosis stages remained modest. Despite minor adverse events requiring brief hospitalization, ESG demonstrated a favorable safety profile. Positioned as a second-line treatment for metabolic dysfunction-associated steatohepatitis (MASH) and obesity, ESG shows potential, especially for patients unresponsive to lifestyle changes. Could this be the breakthrough for non-invasive management of complex metabolic conditions?
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