Endoscopic Sleeve Gastroplasty: Safety and Efficacy Following Liver Transplantation

A Promising Option for Post-OLT Weight Management

Metabolic dysfunction-associated liver disease (MASLD) has become a leading indication for liver transplantation in the U.S., with post-orthotopic liver transplantation (OLT) patients facing risks of weight regain and MASLD recurrence.

Endoscopic Sleeve Gastroplasty (ESG) provides a promising weight loss solution with a safer profile compared to bariatric surgery, particularly addressing infection and dehydration concerns in immunosuppressed patients.

This report presents preliminary findings on the safety and efficacy of ESG in post-OLT patients.

Study Design

This retrospective case series analyzed five patients who underwent Endoscopic Sleeve Gastroplasty (ESG) between 2021 and 2023 to address weight regain following Orthotopic Liver Transplantation (OLT).

Outcomes of ESG in Post-OLT Patients

Procedure Details:

All 5 patients successfully underwent ESG a median of 47.3 months (range: 16.1–150.0) post- OLT.

Patient Demographics:

Predominantly male (4/5; 80%).

Median age: 41 years (range: 41–61 years).

Median BMI: 38.8 kg/m² (range: 31.9–44.8) at the time of ESG.

Follow-Up and Weight Loss:

Median follow-up: 16.2 months (range: 3.4–22.5 months).

Median total body weight loss (TBWL%): 30% (range: 10.3–43.9%) at the end of follow-up.

Medication and Graft Function:

No patients missed doses of immunosuppressive medications.

Liver graft function remained stable during the follow-up period.

Key Insight

In this case series, Endoscopic Sleeve Gastroplasty (ESG) proved to be a safe and effective option for managing weight regain in post-OLT patients.

All patients achieved at least 10% total body weight loss (TBWL), the threshold associated with improvements in liver inflammation and fibrosis.

The median weight loss achieved was comparable to outcomes seen with bariatric surgery, with no significant or long-term adverse events observed.

By - Eeshan Aggarwal

Reference: Hepatology. Volume 80, Issue S1. Abstract Supplement for The Liver Meeting by the American Association for the Study of Liver Diseases (AASLD), November 15-19, 2024, San Diego, CA.