POSE 2.0 Linked to Improved Outcomes in NAFLD Patients With Obesity

A minimally invasive endoscopic procedure was associated with resolution of hepatic steatosis and other benefits in patients with nonalcoholic fatty liver disease (NAFLD) and obesity, a single-center prospective study found.

In an analysis of 42 patients, 52.6% of those who underwent the Primary Obesity Surgery Endoluminal 2.0 (POSE 2.0) procedure, in addition to lifestyle changes, experienced steatosis resolution compared with 0% of those who just changed their lifestyle, reported Maryam Al Khatry, MD, of the United Arab Emirates Ministry of Health & Prevention in Abu Dhabi.

POSE 2.0 patients saw an improvement in controlled attenuation parameter (CAP) -- from 322.6 dB/m at baseline to 235.5 dB/m at 12 months (P<0.0001) -- compared with no improvement in the lifestyle group (P=0.06), she noted during her presentation at the Digestive Disease Week annual meeting.

"A significantly larger number of POSE 2.0 participants had resolution of steatosis, with marked improvements in metabolic parameters," said Andrew Talal, MD, MPH, of the University at Buffalo in New York, who was not involved in this study. "Overall, it appears that POSE 2.0 may be a promising surgical intervention for management of nonalcoholic fatty liver disease in obese individuals."

Furthermore, nearly two-thirds of the POSE 2.0 group achieved a minimum total body weight loss (TBWL) of 10% and showed a greater TBWL response than the lifestyle group at 1 year (17.5% vs 4.0%, respectively).

The POSE 2.0 group also experienced improvements in alanine aminotransferase (P=0.09), aspartate aminotransferase level (AST; P=0.04), hepatic steatosis index (P=0.001), and AST-to-platelet ratio (P=0.02) at 12 months.

Researchers have predicted that NAFLD will become the main cause of end-stage liver disease within the next decade.

"Currently, there are limited therapies to combat the disease," Al Khatry told MedPage Today. "The ability to achieve >10% total body weight loss is an effective treatment modality, but only one in 10 patients are able to reach that threshold of weight loss with even an intensive lifestyle program."

POSE 2.0 "generates full-thickness gastric plications," to shrink the stomach and narrow its aperture, leading to an estimated TBWL of 10% to 15% at 1 year for those with obesity, the authors explained.

"We investigated the POSE 2.0 procedure, which is usually seven plications as exposed from the distal body to the proximal body, shortening the stomach, in order to stimulate satiety by affecting the accommodation and delay of gastric emptying," Al Khatry noted.

For their study, the authors examined data on 42 adults with NAFLD and obesity, 20 of whom underwent the POSE 2.0 procedure with lifestyle modification and 22 who underwent lifestyle changes for 52 weeks in accordance with a high-intensity lifestyle program.

Participants were grouped "based on their desire and motivation" to follow a certain treatment intervention, Al Khatry and team explained. Obesity and NAFLD diagnoses were determined by CAP via liver biochemical testing and FibroScan with XL probe. CAP scores range from 100 to 400 dB/m, with greater values indicating greater amounts of liver fat.

Among both groups, about half of the participants were women, mean age was 32 to 38, mean BMI was 38, and mean CAP was 323 to 339 dB/m. Liver stiffness ranged from 5.2 to 5.5 kPa.

In the POSE 2.0 group, biochemical panel testing showed improvements in HbA1c and HOMA-IR at 6 and 12 months, respectively, while no improvements were seen in the lifestyle group.

No serious adverse events were reported in either group.

"POSE 2.0 was effective for NAFLD, safe, scaleable, accepted by patients, and anatomy sparing," Al Khatry concluded.

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