Fernandez CJ, Jena S, Lakshmi V, Pappachan JM. Duodenal mucosal ablation: An emerging therapeutic concept for metabolic dysfunction-associated fatty liver disease. World J Gastroenterol 2025; 31(28): 109468 [DOI: 10.3748/wjg.v31.i28.109468]
Corresponding Author of This Article
Joseph M Pappachan, MD, FRCP, Professor, Senior Researcher, Faculty of Science, Manchester Metropolitan University, All Saints Building, Oxford Road, Manchester M15 6BH, United Kingdom. drpappachan@yahoo.co.in
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jul 28, 2025; 31(28): 109468 Published online Jul 28, 2025. doi: 10.3748/wjg.v31.i28.109468
Duodenal mucosal ablation: An emerging therapeutic concept for metabolic dysfunction-associated fatty liver disease
Cornelius J Fernandez, Sweekruti Jena, Vijaya Lakshmi, Joseph M Pappachan
Cornelius J Fernandez, Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, Lincolnshire, United Kingdom
Sweekruti Jena, Department of Endocrinology, Kalinga Hospital, Bhubaneshwar 751023, Odisha, India
Vijaya Lakshmi, Department of General Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal 576104, Karnātaka, India
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Department of Endocrinology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnātaka, India
Co-first authors: Cornelius J Fernandez and Sweekruti Jena.
Author contributions: Fernandez CJ and Jena S substantially contributed to article drafting, created the figures, and made equal contributions as co-first authors; Fernandez CJ, Jena S, and Lakshmi V participated in the literature search, contributed to the interpretation of relevant literature; Pappachan JM contributed to the conceptualization and design of the article, and overall supervision of the whole article drafting process. All authors contributed to revision and have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph M Pappachan, MD, FRCP, Professor, Senior Researcher, Faculty of Science, Manchester Metropolitan University, All Saints Building, Oxford Road, Manchester M15 6BH, United Kingdom. drpappachan@yahoo.co.in
Received: May 12, 2025 Revised: May 30, 2025 Accepted: July 3, 2025 Published online: July 28, 2025 Processing time: 73 Days and 2.1 Hours
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD) is currently the leading cause of end-stage liver disease and liver cancer in the world because of the obesity pandemic. Insulin resistance resulting from abdominal adiposity is the main cause of MAFLD and type 2 diabetes mellitus among these patients. Although very common, therapeutic options for MAFLD are currently limited. Metabolic and bariatric surgery is the best treatment option for weight loss that can also improve MAFLD in a very high proportion of patients. However, surgical interventions are expensive, technically challenging, and carry significant immediate and long-term postoperative risks. Duodenal mucosal ablation, a malabsorptive endoscopic bariatric intervention, has shown beneficial effects in the management of obesity with an improvement of insulin resistance. It alters the duodenal mucosal lining, which helps maintain cellular homeostasis and better intestinal endocrine function. This process helps reduce lipid deposition in the liver, maintain serum lipid levels, and promote weight loss, especially in patients with type 2 diabetes mellitus-related MAFLD. However, some of these effects were independent of weight loss and food intake. As a minimally invasive procedure, it is beneficial for patients who have not had success with drug therapy alone, though this approach needs to be tested and further developed in future clinical trials. A basic study by Yu et al in the recent issue of the World Journal of Gastroenterology on duodenal mucosal ablation using irreversible electroporation, when experimented on rats, has shown fewer complications compared to other metabolic surgeries. This editorial describes the minimally invasive endoscopic bariatric strategies for the management of obesity and MAFLD in light of this experimental study.
Core Tip: Metabolic dysfunction-associated fatty liver disease is recognized as the most common cause of chronic liver disease globally with obesity being the prime driver for insulin resistance and hepatic steatosis. Though metabolic and bariatric surgery (MBS) is the most effective treatment option for severe obesity, it carries complication risks and long-term commitment to lifestyle adjustments. In the evolving landscape of obesity management, minimally invasive endoscopic bariatric therapies offer promising weight loss and metabolic benefits with lower complication rates compared to MBS. This editorial provides a comprehensive overview of various endoscopic bariatric techniques used in management of obesity and their effect on metabolic dysfunction-associated fatty liver disease which will help physicians to offer safer alternatives to conventional MBS.
