Johns Hopkins bariatric endoscopist Geri Keane discusses the case of a patient who presented with advanced liver disease, stage 3 fibrosis and hepatic steatosis. Keane performed an endoscopic sleeve gastroplasty (ESG) to help the patient achieve and maintain weight loss and improve liver function. At six weeks post-procedure, the patient had lost nearly 10% of her total body weight and her liver function tests were normal for the first time in 15 years. A multidisciplinary obesity team will now follow the patient closely for the first year following ESG, with a goal of achieving 20% total body weight loss and sustained improvement in her liver disease.
Hello, I'm Jerry Keane. I'm one of the advanced endoscopists and bariatric endoscopists at the Johns Hopkins Hospital in Baltimore and Sibley Memorial Hospital in DC. I'd like to talk to you today about one of my patients who had abnormal liver function tests. She has had abnormal liver function tests for a number of years and has been followed carefully by the Hepatology team who referred her to me. They had diagnosed her with non alcoholic fatty liver disease and had worked her up with an MRI scan to stage her liver disease and found her to have advanced liver disease with stage three fibrosis and hepatic sto tosis. Over the years, she has tried numerous diets and lifestyle interventions to achieve weight loss, but none of these have been successful. Recognizing that she really needs to obtain sustained weight loss. I recommended that she undergoes an endoscopic sleeve gastroplasty. In view of her liver disease, I recognize that we need to work her up for portal hypertension before proceeding with the ESG I therefore, performed AC T scan which confirmed she had no esophageal viruses or gastric viruses. I also undertook an endoscopic ultrasound with portal pressure measurements and an E US guided liver biopsy. This confirmed what we had found on the MRI scan that she had moderate to advanced fibrosis and also that she had no evidence of portal hypertension. So could safely proceed with an ESG. I then proceeded with the ear endoscopic sleeve gastroplasty. This was covered by her insurance to perform this procedure. I use a device which is loaded on the end of an endoscope and allows me to place full thickness sutures through the gastric wall. Bringing these together reduces the stomach size by 75%. This both reduces the size of the stomach but also delays gastric emptying to allow patients to lose weight. The patient was discharged home the same day when I saw her back in clinic at six weeks, she had achieved 9.8% total body weight loss. Her LFTs had normalized for the first time in 15 years. She had made excellent progress. She will now be carefully followed by our multidisciplinary obesity team. She will be seen by our medical obesity specialists and myself. For the next year, I will hope that she will achieve 20% total body weight loss at one year and that she will truly reverse her liver disease and fibrosis. Thank you very much.
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