Obesity promotes more free fatty acids to enter liver cells through insulin resistance, increases liver fat deposition, and leads to an increase in the incidence of NAFLD [6]. Studies have shown that the prevalence of NAFLD is as high as 80% ~ 90% in obese adults, 90% in patients with dyslipidemia and 70% in patients with type 2 diabetes [7]. NAFLD has increased the risk of endothelial dysfunction and arteriosclerosis, which has become an independent risk of cardiovascular disease, and significantly increased the risk of type 2 diabetes (T2DM), hypertension, coronary heart disease and other related diseases, so the prevention and treatment of NAFLD is particularly important.
Because NAFLD is the manifestation of obesity and metabolic syndrome (MS) involving the liver, most patients' liver histological changes are in the stage of simple fatty liver. The therapeutic goal of NAFLD is to lose weight and improve MS, prevent and treat MS, type 2 diabetes and its related complications, thus reducing the burden of disease, improving the quality of life of patients and prolonging their lives.
At present, the basic treatment of NAFLD is to change lifestyle. By adjusting diet structure, reducing calorie intake and increasing physical exercise, insulin resistance, lipid metabolism disorder and liver lipid deposition can be improved. By changing lifestyle, the risk of MS, type 2 diabetes and cardiovascular diseases can also be improved. Sustained and moderate weight loss can improve liver biochemical indexes, such as alanine aminotransferase and aspartate aminotransferase, and improve the histological changes of fatty liver.
However, in reality, there are not many people who can completely implement lifestyle changes and insist on losing weight. For most obese patients, when lifestyle intervention and drug therapy can't achieve the ideal body weight, it is necessary to consider applying metabolic surgery to lose weight. A lot of research and clinical practice have proved that metabolic surgery can lose weight for a long time, increase insulin sensitivity and promote visceral fat reduction. In almost all metabolic surgery studies, improvement of liver function, decrease of liver enzymes, decrease of liver fat content and histological improvement of NAFLD have been observed.
At present, the mainstream surgical methods of weight loss metabolic surgery include laparoscopic gastric sleeve resection and laparoscopic gastric bypass. , mainly through "cutting off the stomach" or "rebuilding the digestive path", reduce the space in the stomach, reduce the food in the stomach, reduce absorption, so as to achieve the effect of losing weight. However, not everyone can do weight loss metabolic surgery. Only patients who meet the surgical indications can receive surgical treatment, and the surgical treatment itself is extremely traumatic, and the changes brought to the patient's body structure are irreversible for life. Some patients need to take vitamin supplements for life after surgery. To some extent, it can also be said that it is "killing one thousand enemies and losing eight hundred", so many patients still have lingering fears.
Principle of gastric bypass stent
However, you don't have to worry too much. With the continuous development of modern endoscopic medicine, endoscopic instrument materials, imaging and clinical experience, minimally invasive surgery through endoscopic intervention has become more and more mature. Take the gastric bypass stent system independently developed by Tangji Medical as an example. It has the advantages of less trauma, higher safety and reversibility, and can benefit patients to the maximum extent. Through this treatment mode, patients can control their weight by adjusting their own functions in a minimally invasive and reversible way without surgery.
Therefore, we have reason to believe that in the near future, endoscopic interventional therapy will have a very good market prospect in the clinical application of metabolic diseases such as obesity and nonalcoholic fatty liver disease, and it is expected to become a new choice for clinical treatment of many patients.
References:
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Wang Fusheng, Fan, Zhang Zhijun, et al. The global burden of liver disease: a great impact on China [J]. Hepatology, 2014,60 (6): 2099-2108.
Fan, Zhu Jun, Li, et al. Prevalence and risk factors of fatty liver in Shanghai [J]. Journal of Hepatology, 2005,43 (3): 508-514.
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