Nonalcoholic steatohepatitis is a growing public health problem affecting over 5% of the population. These patients are at increased risk of cardiovascular and liver-related death and have higher rates of malignancy. The currently standard of care is weight loss and physical exercise, with histological and analytical improvement in patients achieving a 5-10% reduction in body weight. However, less than 25% of the subjects achieve this goal. In obese patients , restrictive surgical treatments and gastric bypass have been successful in improving the metabolic syndrome, insulin resistance and liver histology. Currently, less invasive and less costly endoscopic techniques are being developed. These techniques also achieve a gastric restriction with similar results than bariatric surgery. One of these is the OverStitch® system (Apollo Endosurgery, Austin, TX, USA). Our aim is to evaluate the efficacy and safety of this method in the improvement of liver histology in obese patients with nonalcoholic steatohepatitis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
40
This endoscopic technique is defined as a gastric restriction by means of sutures of the entire gastric wall, transmurally, in order to simulate a gastric sleeve, in the same way as sleeve gastrectomy surgery. Gastroplasty is performed using an endoscopic suture system (OverStitch, Apollo Endosurgery Inc., Austin, Texas, USA) inserted into a dual-channel endoscope (GIF-2T160, Olympus Medical Systems Corp., Tokyo, Japan).
Hypocaloric diet and moderate physical exercise
Jose Luis Calleja
Majadahonda, Madrid, Spain
RECRUITINGTo evaluate the efficacy of gastric tubulization + modification in lifestyle for 72 weeks compared to standard treatment / placebo in the resolution of NASH without worsening of fibrosis.
NASH resolution is defined as the disappearance of ballooning and the disappearance or persistence of minimal lobular inflammation (grade 0 or 1) The worsening of fibrosis is defined as the progression of at least one stage.
Time frame: 72 weeks
Number of patients with improvement of fibrosis according to the CRN score NASH.
to evaluate other histological changes after 72 weeks of treatment (CRN)
Time frame: 72 weeks
Non alcoholic fatty liver disease (NASH) activity score (NAS).
Number of patients with improvement in histological scores CRN score on NASH (NAS)
Time frame: 72 weeks
steatosis-activity-fibrosis index score (steatosis activity fibrosis, SAF).
Number of patients with improvement in the SAF score.
Time frame: 72 weeks
Cardiovascular and death events related to the liver
To evaluate the CV events in patients treated with gastric endoscopic tubulization + lifestyle modification with respect to lifestyle modification / placebo
Time frame: 72 weeks
Changes in liver enzymes
To evaluate liver enzymes in patients treated with gastric endoscopic tubulization + lifestyle modification with respect to lifestyle modification / placebo
Time frame: 72 weeks
Changes in the noninvasive markers of fibrosis and steatosis
To evaluate the noninvasive markers in patients treated with gastric endoscopic tubulization + lifestyle modification with respect to lifestyle modification / placebo
Time frame: 72 weeks
Changes in lipid parameters
To evaluate the lipid parameters in patients treated with gastric endoscopic tubulization + lifestyle modification with respect to lifestyle modification / placebo
Time frame: 72 weeks
Variation in body weight
To evaluate body weight in patients treated with gastric endoscopic tubulization + lifestyle modification with respect to lifestyle modification / placebo
Time frame: 72 weeks
Biomarkers of endothelial and macrophage dysfunction
To evaluate macrophage function in patients treated with gastric endoscopic tubulization + lifestyle modification with respect to lifestyle modification / placebo
Time frame: 72 weeks
Changes in markers of homeostasis of glucose and insulin resistance
To evaluate the glucose metabolism in patients treated with gastric endoscopic tubulization + lifestyle modification with respect to lifestyle modification / placebo
Time frame: 72 weeks
Changes in cardiovascular risk profile
To evaluate cardiovascular risk profile in patients treated with gastric endoscopic tubulization + lifestyle modification with respect to lifestyle modification / placebo
Time frame: 72 weeks
Changes in quality of life (abbreviated health questionnaire SF-36).
To evaluate the following endpoints in patients treated with gastric endoscopic tubulization + lifestyle modification with respect to lifestyle modification / placebo
Time frame: 72 weeks
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