Prospective, Matched Case-Control Study of Endoscopic Sleeve Gastroplasty and Semaglutide in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease at One Year.

Purpose: Endoscopic sleeve gastroplasty (ESG) and GLP-1RA are proven obesity interventions with potential to aid patients who have MASLD. However, their comparative effectiveness remains unclear. This study aimed to compare ESG and semaglutide in MASLD patients regarding weight loss and improvements in metabolic parameters, including liver enzymes, and FIB-4 scores.

Methods: This is an analysis of prospectively collected MASLD registry data from a single tertiary care center. Patients with MASLD were identified through clinical notes, imaging, and pathology. Those treated with semaglutide or undergoing ESG with at least six months of follow-up were included. ESG was performed by a single therapeutic endoscopist using a full-thickness endoscopic suturing device. Anthropometric and laboratory assessments were recorded at baseline and during follow-up. Propensity score matching balanced baseline characteristics, including age, diabetes status, and initial weight.

Results: At 12 months, in matched analysis, ESG resulted in significantly greater %TBWL than semaglutide (Diff 8.29%, p < 0.0001). ALT and AST improvements showed no significant difference between groups. In patients with baseline FIB-4 > 1.3, semaglutide significantly improved FIB-4 scores compared to ESG (0.89, p < 0.0001). Within-group analysis showed significant ALT and AST improvements in both groups over one year, but only semaglutide significantly improved FIB-4 scores compared to baseline (Diff 0.26, p = 0.046).

Conclusion: This analysis demonstrates that both pharmacotherapy and ESG can facilitate ≥ 10% weight loss, leading to improvements in liver parameters associated with MASLD. These treatments should be considered for this patient population, with further studies needed to compare ESG and semaglutide in patients with baseline fibrosis to evaluate their effects.