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Influence of Roux-en-Y Gastric Bypass on the Hepatocellular Function and Bile Flow of Obese Patients Assessed by Scintigraphy with DISIDA

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Abstract

Background

Obesity is associated with nonalcoholic fatty liver disease (NAFLD), which is improved by bariatric surgery. Hepatobiliary scintigraphy with 99m.-Tc diisopropylacetanilido iminodiacetic acid (99mTc-DISIDA) has proved to be highly effective for the assessment of bile flow, representing an indirect measurement of hepatocyte and cholangiocyte function. The objective of this study was to assess the effects of Roux-en-Y gastric bypass (RYGB) on bile flow in obese subjects by hepatobiliary scintigraphy. This study was conducted in a public university hospital in Brazil.

Methods

Twenty obese patients and five nonobese patients (with no hepatic or biliary disease) were studied. The obese patients were submitted to anthropometric evaluation and biochemical exams when they arrived at the service, during the immediate preoperative period and 3, 6, and 12 months after surgery. They were also submitted to abdominal ultrasound and hepatobiliary scintigraphy with 99mTc-DISIDA during the preoperative period and 12 months after RYGB. Tmax (time of maximum marker uptake) and T1/2 (half time between peak uptake and disappearance of the marker) were determined and compared between obese patients and controls, before and after surgery. The results were compared to those obtained with an intraoperative liver biopsy.

Results

A weight loss of 12.2 ± 4.3 % was observed during preparation for surgery, and a loss of 30.4 ± 5.6 % was observed 1 year after RYGB. Ultrasound hepatic analysis revealed some degree of NAFLD in the operated patients. Obese patients showed a prolonged T1/2 compared to control, with a reduction to normal levels after RYGB.

Conclusions

We concluded that NAFLD compromises bile excretion, a process that can be reversed by treatment with RYGB.

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Authors and Affiliations

  1. Department of Surgery and Anatomy, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

    Wilson Salgado Júnior, Carlos Augusto de Mattos Donadelli & José Sebastião dos Santos

  2. Nutritional Division of the Department of Medical Clinic, Clinical Hospital, Faculty of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

    Carla Barbosa Nonino

Authors
  1. Wilson Salgado Júnior
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  2. Carlos Augusto de Mattos Donadelli
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  3. José Sebastião dos Santos
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  4. Carla Barbosa Nonino
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Corresponding author

Correspondence to Wilson Salgado Júnior.

Ethics declarations

The study was approved by the Research Ethics Committee of HCRP-FMRP-USP (protocol 1953/2009) National Health Council, and Ethics in Research National Committee of the Brazilian Health Ministry. All patients gave written informed consent to participate.

Conflict of Interest

We the authors declare that this study was neither published nor under consideration to be published elsewhere and that there was no personal conflict of interests or financial ties since we have not received any funding, equipment, or drugs from industry.

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Salgado Júnior, W., Donadelli, C.A.d.M., dos Santos, J.S. et al. Influence of Roux-en-Y Gastric Bypass on the Hepatocellular Function and Bile Flow of Obese Patients Assessed by Scintigraphy with DISIDA. OBES SURG 26, 2718–2723 (2016). https://doi.org/10.1007/s11695-016-2176-2

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