INTRODUCTION AND OBJECTIVES: With increases in obesity and metabolic syndrome because of lifestyle-related factors, the prevalence of non-alcoholic fatty liver disease (NAFLD) also is increasing worldwide. In a subset of patients with NAFLD, an inflammatory process arises in the steatotic liver, known as non-alcoholic steatohepatitis, that leads to liver fibrosis and liver cirrhosis. In selected patients with obesity, bariatric surgery, and bariatric endoscopy are important therapeutic options. MATERIALS AND METHODS: This prospective interventional pilot study was conducted to investigate two types of intragastric balloons (IGB). The IGBs were the Orbera and the Spatz3. Liver fibrosis changes were monitored non-invasively using point and 2D shear wave ultrasound elastography (SWE) and transient elastography that allowed for quantification of liver steatosis using the controlled attenuation parameter (CAP). Patients were followed for 12 months. RESULTS: Of 34 patients implanted with an IGB, 30 completed follow-up at month 12; results for one patient were excluded because of initiation of obesity pharmacotherapy. Fifteen patients received the Orbera IGB, and nineteen patients received the Spatz3 type. In month 12, total and excess weight loss was 7.88 % and 30.13 %. Elastography values decreased from baseline (3.88 kPa) to 3.61 kPa at month 12 (p 0.024). 2D SWE values decreased from baseline (5.42 kPa) to a value of 4.91 kPa at month twelve (p 0.135). Transient elastography values decreased from baseline (5.62 kPa) to a value of 4.17 kPa at month twelve (p 0.009). CONCLUSIONS: Bariatric endoscopy in the form of IGB implantation leads to weight reduction and improvement of liver fibrosis and steatosis. GOV REGISTRATION: NCT04895943.

Department of Clinical Studies Faculty of Medicine University of Ostrava Syllabova 19 70030 Ostrava Czech Republic

Department of Epidemiology and Public Health Faculty of Medicine University of Ostrava Syllabova 19 70030 Ostrava Czech Republic

Department of Internal Medicine 2 Gastroenterology and Geriatrics Faculty of Medicine and Dentistry Palacky University Olomouc and University Hospital Zdravotníků 248 7 779 00 Olomouc Czech Republic

Department of Internal Medicine and Cardiology Division of Gastroenterology hepatology and pancreatology University Hospital Ostrava 17 Listopadu 1740 70800 Ostrava Czech Republic

Department of Physiology and Pathophysiology Faculty of Medicine University of Ostrava Syllabova 19 70030 Ostrava Czech Republic

Institute of Laboratory Medicine University Hospital Ostrava 17 Listopadu 1740 70800 Ostrava Czech Republic

Research and Education department University Hospital Ostrava 17 Listopadu 1740 70800 Ostrava Czech Republic

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