ORIGINAL ARTICLE Endoscopic sleeve gastroplasty — minimally invasive treatment for non-alcoholic fatty liver disease and obesity Nitin Jagtap 1 & Rakesh Kalapala 1 & Abhishek Katakwar 2 & Mithun Sharma 1 & Mohsin Aslam 1 & Rajesh Gupta 1 & P Nagaraja Rao 1 & Rajesh Goud 1 & Manu Tandan 1 & Haranath Kanakagiri 3 & Santosh Darishetty 3 & D. Nageshwar Reddy 1 Received: 13 August 2020 /Accepted: 24 May 2021 # Indian Society of Gastroenterology 2021 Abstract Introduction Adequate weight loss can lead to reduction in steatosis, inflammation, and fibrosis in patients with obesity and non- alcoholic fatty liver disease (NAFLD). We evaluated the role of endoscopic sleeve gastroplasty (ESG) in patients with obesity and NAFLD. Methods In this single-center prospective study, consecutive adult patients with NAFLD who underwent ESG be- tween November 2018 and May 2019 were included. The primary outcome was the impact of ESG on hepatic parameters: change in alanine aminotransferase (ALT), hepatic steatosis index (HSI), NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4), and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) from baseline to 6 and 12 months. Secondary outcomes included change in glycated hemoglobin (HbA1c), percentage weight loss, and safety. Analysis of variance with repeated measures was used for statistical analysis. Results A total of 26 patients (mean age [SD] 41.5 [9.58] years; 16 females) with mean (SD) weight of 99.43 (21.89) kg at baseline were included. There was significant improvement in ALT (mean ± SD) from baseline of 59.54 ± 17.02 IU/L to 49.50 ± 11.72 IU/L and 48.42 ± 13.22 IU/L at 6 and 12 months (p = 0.001). Mean (SD) NFS was significantly improved from 0.228 (1.00) at baseline to -0.202 (1.16) and -0.552 (1.08) at 6 and 12 months (p 0.001). Mean (SD) HSI, FIB-4, and APRI scores significantly reduced from baseline to 6 and 12 months (p = 0.001). There was 18.07% total body weight loss at 12 months, with significant improvement in HbA1c. There were no major adverse events. Conclusion ESG is a safe and effective treatment option for patients with NAFLD and obesity causing significant weight loss. Rigorous randomized trials are required to incorporate ESG in NAFLD treatment algorithm. Keywords Bariatric endoscopy . Diabetes mellitus . Endoscopic bariatric and metabolic therapies . Endoscopic sleeve gastroplasty . Fatty liver . Fibrosis . Insulin resistance . Metabolic syndrome . Non-alcoholic steatohepatitis . Safety . Treatment . Weight loss * Nitin Jagtap docnits13@gmail.com 1 Department of Medical Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad 500 082, India 2 Department of Metabolic and Bariatric Surgery, Asian Institute of Gastroenterology, Hyderabad 500 082, India 3 Department of Anesthesiology, Asian Institute of Gastroenterology, Hyderabad 500 082, India Indian Journal of Gastroenterology https://doi.org/10.1007/s12664-021-01202-7