title: Effect of Intragastric Balloons on Liver Enzymes: A Systematic Review and Meta-Analysis.
abstract: Intragastric balloons (IGBs) are safe and effective in inducing weight loss in obese patients. The objective of this study was to review and analyze the available data of the effect of IGB on markers of nonalcoholic fatty liver disease (NAFLD) and liver enzymes.
  
  
  
  Searches were performed of MEDLINE and Embase databases from inception through January 2016. Study inclusion criteria were the following: ≥5 overweight or obese adult patients undergoing intragastric balloon placement, with liver tests [alanine aminotransferase (ALT) or gamma-glutamyl transpeptidase (GGT)] or markers of NAFLD (e.g., imaging, biopsy) reported before balloon insertion and after balloon removal at 6 months.
  
  
  
  Nine observational studies and one randomized trial were identified. ALT decreased by -10.02 U/l (95 % CI, -13.2, -6.8), GGT decreased by -9.82 U/l (95 % CI, -12.9, -6.8), and BMI decreased by -4.98 kg/m(2) (-5.6, -4.4) with IGB therapy. Hepatic steatosis improved from baseline after 6 months of balloon therapy by magnetic resonance imaging (fat fraction, 16.7 ± 10.9-7.6 ± 9.8, p = 0.003), ultrasound (severe liver steatosis, 52-4 %, p < 0.0001). Histological NAFLD activity score was lower after 6 months of IGB versus control with sham endoscopy and diet (2 ± 0.75 vs. 4 ± 2.25, p = 0.03).
  
  
  
  The use of intragastric balloon decreases liver enzymes and is potentially an effective short-term treatment for NAFLD as part of a multidisciplinary approach. Larger, more rigorous trials are needed to confirm the effect of IGBs on NAFLD.
authors.affiliation: NYU Langone Medical Center and VA NY Harbor Healthcare System, 423 East 23rd Street, 11 North, New York, NY, 10010, USA. Violeta.popov@nyumc.org.
authors.forename: Violeta B
authors.initials: VB
authors.lastname: Popov
authors.affiliation: Division of Gastroenterology and Hepatology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Thorne 14, Boston, MA, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Thompson
authors.affiliation: Division of Gastroenterology and Hepatology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Thorne 14, Boston, MA, USA.|Bariatric Endoscopy Institute Gastroenterology Weight Management, Addison, IL, 60101, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Ciarleglio
authors.affiliation: Yale Center for Analytical Sciences, Yale University, 300 George Street, Suite 555, New Haven, CT, 06515, USA.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Deng
authors.affiliation: Yale School of Medicine and VA Connecticut Healthcare System, PO Box 208019, New Haven, CT, 06520, USA.
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D050110:Bariatric Surgery / Q000379:methods*; D015905:Gastric Balloon; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D009765:Obesity / Q000097:blood / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography; D015431:Weight Loss; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase
keywords: Intragastric balloon; Liver enzymes; Nonalcoholic fatty liver disease; Obesity