Short-Term Impact of Endoscopic Gastric Remodeling in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD), a leading cause of chronic liver disease in the United States, is linked to obesity and insulin resistance. Endoscopic gastric remodeling (EGR) offers a safe and effective minimally invasive approach for MASLD. It is associated with improvements in noninvasive fibrosis test (NIT), liver enzymes, weight reduction, and metabolic parameters than bariatric surgery in the management of obesity. EGR includes three primary approaches: endoscopic sleeve gastroplasty (ESG), endoscopic gastric plication (EGP), and primary obesity surgery endoluminal (POSE). AIM: To evaluate the effects of EGR on MASLD-related liver outcomes and metabolic parameters. METHODS: A systematic search of multiple electronic databases, including conference proceedings, was conducted from database inception through November 2025 to identify studies reporting hepatic or metabolic outcomes following EGR. Weighted mean differences and pooled proportions were calculated using a fixed-effects model. Heterogeneity was assessed using Cochran's Q test. Primary outcomes included changes in noninvasive fibrosis indices: NAFLD Fibrosis Score (NFS), fibrosis-4 (FIB-4), and hepatic steatosis index (HSI). Secondary outcomes included liver enzymes, weight loss metrics, and glycemic parameters. RESULTS: Six studies comprising 220 patients (mean age 45 years; 67.5% female; mean baseline body mass index 38.9 kg/m²) with follow-up ranging from 6 to 12 months. EGR was associated with significant improvements in liver fibrosis indices, including NFS (mean difference - 0.65; 95% CI - 0.89 to - 0.42), FIB-4 (mean difference - 0.07; 95% CI - 0.22 to 0.07), and HSI (reduced from 50.36 ± 3.00 to 42.66 ± 2.38). Reductions in liver enzymes were observed, with pooled decreases of 14.39 U/L in alanine aminotransferase and 6.58 U/L in aspartate aminotransferase. EGR resulted in weight loss, with a pooled percent excess weight loss of 47.80% and a percent total weight loss of 16.24%. Glycemic control improved, with a 0.33% reduction in hemoglobin A1c and a 62% decrease in insulin resistance. No significant publication bias was detected (Begg-Mazumdar Kendall's tau b - 0.20, p = 0.48). CONCLUSIONS: Endoscopic gastric remodeling is a safe and effective minimally invasive therapy for MASLD. Further long-term studies are warranted to confirm the durability of these benefits.