Liver Decompensation after Bariatric Surgery in the Absence of Cirrhosis

Berg, Perrine Vande; Ulaj, A.; Broqueville, Graziella de; Vos, M. De; Delire, Bénédicte; Hainaut, Philippe; Thissen, Jean‐Paul; Stärkel, Peter; Komuta, Mina; Henry, Paulina; Lanthier, Nicolas

doi:10.1007/s11695-022-05930-3

Cited by 7 publications

(7 citation statements)

References 32 publications

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“…A combination of malnutrition and non-adherence to nutritional supplements can lead to liver failure. Clinical improvement with conservative treatment and appropriate nutritional support seems to be effective, as recently described by Vandeberg et al and Van Golen et al (51)(52). Consideration of a reversal of malabsorptive BS procedures can be considered in patients presenting with edema or ascites due to hypoalbuminemia in order to improve malnutrition and stabilization of liver disease.…”

Section: The Bidirectional Relationship Between Obesity and Alcoholmentioning

confidence: 85%

Liver health and the interplay between obesity, alcohol and bariatric surgery

Geerts

Onghena

Lefere

2023

AGEB

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The prevalence of obesity and metabolic consequences, including non-alcoholic fatty liver disease (NAFLD) has become a global health problem. Obesity has an important impact on chronic liver disease even beyond NAFLD, as it accelerates the progression of alcohol liver disease. Conversely, even moderate alcohol use can affect NAFLD disease severity. Weight loss is the gold standard treatment but adherence to lifestyle changes is very low in the clinical setting. Bariatric surgery can improve metabolic components and cause long-term weight loss. Therefore, bariatric surgery could serve as an attractive treatment option for NAFLD patients. A pitfall is the use of alcohol after bariatric surgery. This short review integrates data about the influence of obesity and alcohol on liver function and the role of bariatric surgery.

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Section: The Bidirectional Relationship Between Obesity and Alcoholmentioning

confidence: 85%

Liver health and the interplay between obesity, alcohol and bariatric surgery

Geerts

Onghena

Lefere

2023

AGEB

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“…Although it is generally considered that SG has a lower perioperative risk profile than bypass-type procedures, there is limited data on safety and efficacy of different BMS procedures for this cohort of patients. Furthermore, in patients with advanced liver disease it is important to consider the potential effect of bypass on liver function as there are reports of liver decompensation in patients with no pre-existing diagnosis of cirrhosis following a gastric bypass 32 . However, in the current study, this effect was not noted during the 30-day follow-up.…”

Section: Discussionmentioning

confidence: 99%

Safety outcomes of bariatric surgery iN patients with advanced oRgan disease: the ONWARD study - a prospective cohort study

Singhal,

Cardoso,

Wiggins

et al. 2023

International Journal of Surgery

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Introduction: Increasing numbers of patients with advanced organ disease are being considered for Bariatric and Metabolic Surgery (BMS). There is no prospective study on the safety of BMS in these patients. This study aimed to capture outcomes for patients with advanced cardiac, renal, or liver disease undergoing BMS. Materials and Methods: This was a multinational, prospective cohort study on the safety of elective BMS in adults (≥18 y) with advanced disease of the heart, liver, or kidney. Results: Data on 177 patients with advanced diseases of heart, liver, or kidney were submitted by 75 centres in 33 countries. Mean age and Body Mass Index was 48.56±11.23 years and 45.55±7.35 kg/m 2 respectively. Laparoscopic sleeve gastrectomy was performed in 124 patients (70%). The 30-day morbidity and mortality were 15.9% (n=28) and 1.1% (n=2) respectively. 30-day morbidity was 16.4%, 11.7%, 20.5%, and 50.0% in patients with advanced heart (n=11/61), liver (n=8/68), kidney (n=9/44), and multi-organ disease (n=2/4) respectively. Cardiac patients with left ventricular ejection fraction ≤35% and New York Heart Association classification 3 or 4, liver patients with Model for End-Stage Liver Disease score ≥12, and patients with advanced renal disease not on dialysis were at increased risk of complications. Comparison with a propensity score matched cohort found advanced disease of the heart, liver, or kidney to be significantly associated with higher 30-day morbidity. Conclusion: Patients with advanced organ disease are at increased risk of 30-day morbidity following BMS. This prospective study quantifies that risk and identifies patients at the highest risk.

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“…In view of this jaundice associated with oedema of the lower limbs in a patient who had undergone a gastric bypass operation and was at risk of malnutrition, we suggested the diagnosis of massive steatosis and liver insufficiency secondary to the bypass, following the occurrence of similar cases (2). The patient was transferred to our institution for a transvenous biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…Bariatric surgery is currently the most effective treatment for sustained weight loss, also providing improved glycemic control better than conventional weight-loss therapies. However, with the rising use of bariatric surgery, there is also greater awareness of its complications, such as the development of liver injury for a subset of patients (2)(3)(4). A large proportion of patients presenting for bariatric surgery procedures have varying stages of steatosis and MAFLD (5).…”

Section: Introductionmentioning

confidence: 99%

“…The weight loss accomplished with bariatric surgery carries beneficial effects on these hepatic complications and leads to notable improvements in hepatic steatosis and fibrosis (5,6). Unfortunately, complex interactions including malnutrition, altered enterohepatic metabolism, and potential external triggers can lead to liver injury and liver decompensation in a subset of patients (2)(3)(4). Problems related to the alcohol consumption are also described (7,8).…”

Section: Introductionmentioning

confidence: 99%

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Are elevated systemic bile acids involved in the pathophysiology of sarcopenia and liver injury following gastric bypass?

Bourseau

Bozadjieva-Kramer

Goffaux

et al. 2023

AGEB

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Bariatric surgery is currently the most effective treatment for sustained weight loss in severe obesity. However, recent data describe the development of liver damage and in particular massive steatosis and cholangitis in some patients, for which certain pathophysiological mechanisms are suggested such as bacterial overgrowth, malabsorption or sarcopenia. We describe the case of a patient presenting with a new liver dysfunction 6 years after a gastric bypass. The work-up revealed sarcopenic obesity characterised by low muscle mass and low muscle function as well as elevated fasting bile acids, severe liver steatosis and cholangitis. The pathophysiology of this disease is complex and multifactorial but could include bile acid toxicity. Bile acids are increased in cases of liver steatosis, but also in cases of gastric bypass and malnutrition. In our opinion, they may contribute to the loss of muscle mass and the vicious circle observed in this situation. Treatment with enteral feeding, intravenous albumin supplementation and diuretics reversed the liver dysfunction and the patient was discharged from hospital

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Liver Decompensation after Bariatric Surgery in the Absence of Cirrhosis

Cited by 7 publications

References 32 publications

Liver health and the interplay between obesity, alcohol and bariatric surgery

Liver health and the interplay between obesity, alcohol and bariatric surgery

Safety outcomes of bariatric surgery iN patients with advanced oRgan disease: the ONWARD study - a prospective cohort study

Are elevated systemic bile acids involved in the pathophysiology of sarcopenia and liver injury following gastric bypass?

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