Current Controversies in Metabolic Surgery for Nonalcoholic Fatty Liver Disease

Perysinakis, Iraklis; Pappis, Harilaos C.; Margaris, Elias

doi:10.1007/s11695-019-03705-x

Cited by 13 publications

(5 citation statements)

References 69 publications

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“…Bariatric surgery presents an accepted treatment modality for NAFLD [ 6 , 11 , 12 , 17 , 25 , 26 ]. However, evidence on the modality of choice with regard to NAFLD (SG or RYGB) is sparse and a statement regarding the operative approach is lacking in the guidelines [ 26 , 27 ]. While some studies suggest superiority for one of the operative procedures, others advocate their equality [ 12 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…While some studies suggest superiority for one of the operative procedures, others advocate their equality [ 12 , 25 ]. A paramount concern about bariatric surgery in patients with chronic liver disease is potential worsening of preexisting liver conditions, underlining the importance of NAFLD assessment prior to surgery [ 19 , 26 , 28 , 29 ]. Aim of this study was to assess the impact of SG and RYGB on recovery or worsening of liver function in patients with obesity after bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass

et al. 2021

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Background Nonalcoholic fatty liver disease (NAFLD) is a common condition in patients with obesity. Bariatric surgery has often been proposed as a viable treatment option, but the ideal surgical procedure remains unclear. Inconsistently, reports on postoperative deterioration of liver function put further doubt on which technique to apply. Aim of this study was to assess the impact of Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) on the postoperative recovery of liver function. Methods A total of 175 patients with obesity that underwent bariatric surgery in our institution were included in this prospective cohort study. BMI, laboratory values, and liver function capacity (using LiMAx) were assessed preoperatively and at 6 and 12 months postoperatively. Generalized linear model (GLM) was performed to determine variables influencing liver function capacity after the operation. Results Prior to operations, 64% of patients presented with a diminished liver function capacity, as measured by LiMAx test. Liver function capacity significantly recovered after 12 months in the SG group (300 μg/kg/h preop vs. 367 μg/kg/h postop) but not in the RYGB group (306 μg/kg/h preop vs. 349 μg/kg/h). Preoperative factors impeding liver function recovery included type 2 diabetes mellitus (T2DM), weight, male sex, AST/thrombocyte ratio (APRI), and gamma-glutamyltransferase (GGT). Conclusion Bariatric surgery, especially sleeve gastrectomy, leads to an improvement of liver function. However, in some patients with T2DM, higher preoperative weight and male sex postoperative deterioration of liver function capacity may occur. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass

et al. 2021

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“…It is important to point out the evidence-base to date is conflicting ( 30 , 31 ). Billeter et al reported that SG was superior to RYGB in terms of its reduction in markers of liver function in patients with combined NAFLD and T2DM, whereas both procedures had comparable effects on improving glycemic control in patients with T2DM ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Combined non-alcoholic fatty liver disease and type 2 diabetes in severely obese patients—medium term effects of sleeve gastrectomy versus Roux-en-Y-gastric bypass on disease markers

Billmann¹,

Shishtawi²,

Bruckner³

et al. 2022

Hepatobiliary Surg Nutr

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Background: we aimed to evaluate the medium-term efficacy of sleeve gastrectomy (SG) vs. Roux-en-Y gastric bypass (RYGB) on remission of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM).Methods: We identified severely obese patients (BMI >35 kg/m 2 ) with NAFLD (as defined by the Longitudinal Assessment of Bariatric Surgery Study) and T2DM (as defined by the American Association of Clinical Endocrinologists and the American College of Endocrinology) who underwent SG or RYGB in a single university surgical centre. The cohorts were match-paired and data were analysed after at least 3 years of follow up. The key outcomes measured were: (I) the improvement of liver function tests and NAFLD markers; (II) glycemic control and insulin resistance.Results: Ninety six patients were investigated; 44 (45.8%) were women. The mean pre-operative BMI was 45.2 kg/m 2 in the SG and 42.0 kg/m 2 in the RYGB group. SG and RYGB both significantly reduced serum liver enzyme concentrations. NAFLD markers resolved 2 years after SG in all patients. In contrast, only 78% and 80% of patients achieved remission of NAFLD 2 and 3 years after RYBG respectively. Both procedures resulted in comparable rates of remission of T2DM.Conclusions: Bariatric surgery with SG may be preferable to RYGB for obese patients with NAFLD and T2DM based on the rates of remission of markers of these co-morbidities. However, our results need to be confirmed in prospective trials. Understanding the metabolic effects of specific bariatric surgical procedures may facilitate the development of a personalised approach to weight-loss surgery.

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“…While BS has been shown to have a protective effect against the onset and/or the progression of non-alcoholic steatohepatitis (NASH) and liver cirrhosis [4], patients with a previous history of BS may become candidate to liver transplantation (LT) because of acute or chronic liver failure or development of primary liver tumors [5]. Alcoholrelated end-stage liver disease may occur due to a shift in the addictive profile from food to alcohol [6][7][8], the occurrence of hepatocarcinoma (HCC) on NASH, or the progression of NASH in spite of BS [9,10]. Whatever the indication for LT, liver transplant surgeons are facing more and more patients candidates to LT with a previous history of BS, and it may be speculated that in the foreseeable future, this association will be even more frequent due to the deep penetration of BS and the worldwide epidemic of obesity [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Economic Impact of Previous Bariatric Surgery on Liver Transplantation: a Nationwide, Population-Based Retrospective Study

et al. 2021

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Purpose The present study aims to determine the impact of previous bariatric surgery (BS) on the length of hospital stay; the incidence of mortality, re-transplantation, and re-hospitalization after LT; and the related economic costs, through the analysis of the French National Health Insurance Information System. Materials and Methods All patients aged > 18 years who underwent LT in France in the period from 2010 to 2019 were included. Thirty-nine patients with a history of BS (study group) were compared with 1798 obese patients without previous BS (control group). Results At the time of LT, patients with a history of BS were significantly younger than those of the control group and had lower Charlson comorbidity index. Female sex was significantly more represented in the study group. No significant differences were detected between the two groups regarding the postoperative mortality rate after LT (10.3% in the study group versus 8.0% in the control group), long-term mortality (0.038 versus 0.029 person-year of follow-up, respectively), re-transplantation (adjusted hazard ratio (HR) = 2.15, p = 0.2437), re-hospitalization (adjusted analysis, IRR = 0.93, p = 0.7517), and costs of LT hospitalization (73,515 € in the study group versus 65,878 € in the control group). After 1:2 propensity score matching, the duration of the LT hospital stay was significantly longer in the study group (58.3 versus 33.4 days, p = 0.0172). Conclusion No significant differences were detected between patients with previous BS versus obese patients without history of BS undergoing LT concerning the rates of mortality, re-LT, re-hospitalization after LT, and costs of hospitalization and re-hospitalizations. Graphical abstract

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Current Controversies in Metabolic Surgery for Nonalcoholic Fatty Liver Disease

Cited by 13 publications

References 69 publications

Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass

Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass

Combined non-alcoholic fatty liver disease and type 2 diabetes in severely obese patients—medium term effects of sleeve gastrectomy versus Roux-en-Y-gastric bypass on disease markers

Clinical and Economic Impact of Previous Bariatric Surgery on Liver Transplantation: a Nationwide, Population-Based Retrospective Study

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