Endoscopic Sleeve Gastroplasty for fatty liver disease and metabolic syndrome

Patients with Non-alcoholic fatty liver disease, who are obese (BMI 30- 45Kg/m2) will be assessed for the intervention. This will include a liver biopsy to assess the degree of fatty liver disease. If included in the trial, the intervention is an Endoscopic Sleeve gastroplasty (ESG) which will be undertaken under general anesthetic in patients with non-alcoholic fatty liver disease and metabolic risk factors. The procedure will be performed at Auckland City Hospital, the interventional endoscopist is Dr David Orr, who has been undertaking interventional endoscopy at Auckland Hospital for >12 years and at King's College Hospital, London before this time. Patients will be assessed and followed up by a specialist team of bariatric nurse, dietician and psychologist. The procedure duration is 1.5 hours. A gastroscope is passed into the stomach to confirm that there are no contra-indications to proceeding with the ESG. The stomach is then marked to show the orientation of the stomach for the endoscopist during the procedure. The Overstitch device is then attached to the endoscope and placed into the stomach. Approximately 8 stitches are placed in a double layer pattern to reduce the diameter and shorten the stomach. You will remain in hospital for one night post procedure. After discharge, you will be seen in outpatient clinic at week 1, then monthly for 3 months, then every 3 months for up to 2 years at Auckland Hospital. 1 year after the procedure, you will undergo a repeat liver biopsy to assess if the ESG has resulted in improvement and/or resolution of your non-alcoholic fatty liver disease. As part of standard of care, you will continue follow up in the hepatology clinic every 3 months after the procedure.