Inclusion Criteria:  Patient is 18-65 years old Obesity (defined as BMI > 30 kg/m2) Biopsy-proven NASH (defined as the presence of steatosis and hepatic injury in the form of ballooning or lobular inflammation)19 Advanced fibrosis (defined as bridging fibrosis (F3) or cirrhosis (F4) on LB).  Exclusion Criteria:  Decompensated cirrhosis (defined as bleeding varices, ascites, encephalopathy and jaundice) gastric varices diabetes mellitus (defined as HbA1c ≥ 6.5%) active smoking being on an anticoagulant or anti-platelet medication active participation in any weight loss program, the use of a weight loss medication over the past 6 months and history of bariatric surgery or EBMT. Patients with esophageal varices are not excluded as long as they are on a non-selective beta-blocker for primary prophylaxis. Patient is pregnant, breast-feeding, or planning to become pregnant during the course of the study. Patient is unwilling or unable to sign and date the informed consent. Patient is unwilling or unable to comply with the follow-up study schedule. Patient for whom endoscopic procedures are contraindicated.