Influence of Sleeve Gastrectomy on NASH and Type 2 Diabetes Mellitus

Abstract

Background. Nonalcoholic fatty liver disease is present in up to 85% of adipose patients and may proceed to nonalcoholic steatohepatitis (NASH). With insulin resistance and obesity being the main risk factors for NASH, the effect of isolated sleeve gastrectomy (ISG) on these parameters was examined. Methods. 236 patients underwent ISG with intraoperative liver biopsy from December 2002 to September 2009. Besides demographic data, pre-operative weight/BMI, HbA1c, AST, ALT, triglycerides, HDL and LDL levels were determined. Results. A significant correlation of NASH with higher HbA1c, AST and ALT and lower levels for HDL was observed (P < .05, <.0001, <.0001, <.01, resp.). Overall BMI decreased from 45.0 ± 6.8 to 29.7 ± 6.5 and 31.6 ± 4.4 kg/m2 at 1 and 3 years. An impaired weight loss was demonstrated for patients with NASH and patients with elevated HbA1c (plateau 28.08 kg/m2 versus 29.79 kg/m2 and 32.30 kg/m2 versus 28.79 kg/m2, resp.). Regarding NASH, a significant improvement of AST, ALT, triglyceride and HDL levels was shown (P < .0001 for all). A resolution of elevated HbA1c was observed in 21 of 23 patients. Summary. NASH patients showed a significant loss of body weight and amelioration of NASH status. ISG can be successfully performed in these patients and should be recommended for this subgroup.

Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review

“…[115][116][117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132][133] A schematic representation of the search in the online databases and the identification, exclusion and selection of the articles is presented in Figure 1.…”

“…In an analysis on prospective data gathered from 236 individuals, Karcz et al 128 observed significant improvements in AST, ALT, triglycerides and high-density lipoprotein (HDL) levels one and three years after SG. NASH patients showed significant losses of body weight and amelioration of NASH status.…”

Non-alcoholic fatty liver disease resolution following sleeve gastrectomy

“…NAFLD is becoming a prevalent chronic liver disease, due to the association with the ever-increasing rates of morbid obesity and metabolic syndrome. The rise is alarming, as the disease has been seen to cascade from steatohepatitis to fibrosis and liver cirrhosis and eventually even hepatocellular carcinoma [19]. NAFLD also increases the risk of multiple cardiac and metabolic diseases [20].…”

“…In the study by Karcz et al [19], the effect of LSG on NAFLD and diabetes was observed using an intra-operative liver biopsy and postoperative liver enzyme monitoring. An observation of significant NAFLD resolution was found, very much similar to this study, but this was solely based on an improvement in postoperative liver function test results.…”

Diabetic and bariatric surgery: A review of the recent trends

“…Many studies have reported a resolution rate of 60-90% for diabetes after sleeve gastrectomy in the short term (6 months to 1 year) [40][41][42][43][44][45][46][47][48][49]. Other studies have reported inferior results for diabetes resolution [50][51][52][53].…”