The role of endoscopic therapies for patients with metabolic dysfunction-associated steatotic liver disease (MASLD)

ESG could be a promising, minimally invasive option for patients with MASLD who are ineligible for bariatric surgery or refractory to medical therapy. Early data suggest clinically meaningful weight loss, metabolic improvement, and a favorable safety profile, but long-term outcomes and direct histological benefits remain to be defined, particularly in patients with advanced fibrosis or cACLD. Combining ESG with pharmacological agents, such as GLP-1 receptor agonists, theoretically may enhance outcomes and deserves further study. Well-designed trials are required to better define the role of ESG in MASLD management and its potential integration into clinical practice.