Gastrointestinal Endoscopy · Mar 3, 2026

Endoscopic gastric remodeling and its histologic impact on metabolic dysfunction-associated steatohepatitis: a 12-month prospective study

By Jirapinyo P, Papke DJ, Garcia-Tsao G et al.

BACKGROUND AND AIMS: Weight loss through lifestyle modification or glucagon-like peptide-1 receptor agonists (GLP-1RAs) is first-line therapy for metabolic dysfunction-associated steatohepatitis (MASH). However, few subjects achieve sufficient weight loss with lifestyle changes, and long-term medication use limits GLP-1RA adoption. This study evaluated the effect of endoscopic gastric remodeling (EGR), a 1-time, minimally invasive intervention, on MASH histologic features. METHODS: In this 12-month prospective study, subjects with obesity and biopsy-proven MASH with fibrosis underwent EGR using the U.S. Food and Drug Administration-cleared endoscopic plication device. Baseline and follow-up assessments included EUS-guided liver biopsy and portosystemic pressure gradient measurement. RESULTS: Twenty subjects underwent EGR; 13 completed 12-month follow-up. Median weight decreased by 16.5%, with 73% achieving ≥10% total weight loss. MASH resolution occurred in 46%, fibrosis improvement in 54%, and nonalcoholic fatty liver disease Activity Score improved in 85%, with significant reductions in portosystemic pressure gradient. No serious adverse events occurred. CONCLUSIONS: EGR improves histologic MASH and fibrosis and represents a promising minimally invasive therapy.

doi.org/10.1016/j.gie.2026.02.042PubMed 41786151Interventions