Endoscopic sleeve gastrectomy vs traditional bariatric surgery: A paradigm shift in managing metabolic dysfunction-associated steatohepatitis and cirrhosis?

Table 1 Recommendations based on liver disease severity

Liver disease severity	Guideline recommendation
No cirrhosis	Follow standard bariatric surgery guidelines
Compensated cirrhosis (Child-Pugh A)	LSG or ESG may be considered in high-volume centers with hepatology involvement
Clinically significant portal hypertension or Child-Pugh B	Proceed with extreme caution, with multidisciplinary evaluation
Decompensated cirrhosis (Child-Pugh C)	Avoid bariatric surgery outside of liver transplant settings

LSG: Laparoscopic sleeve gastrectomy; ESG: Endoscopic sleeve gastroplasty.