Advertisement

Longitudinal Comparison of the Effect of Gastric Bypass to Sleeve Gastrectomy on Liver Function in a Bariatric Cohort: Tehran Obesity Treatment Study (TOTS)

  • Mohammad Ali Kalantar Motamedi
  • Alireza Khalaj
  • Maryam Mahdavi
  • Majid Valizadeh
  • Farhad Hosseinpanah
  • Maryam Barzin
Original Contributions

Abstract

Background

Patients with morbid obesity commonly have fatty liver disease and elevated liver enzymes. While surgery effectively induces weight loss, bariatric techniques may differ regarding liver function improvement.

Objectives

To evaluate and compare the trends of liver function recovery after gastric bypass surgery (GB) with sleeve gastrectomy (SG).

Setting

University hospitals, Iran.

Methods

Adult bariatric candidates without a history of alcohol consumption or other etiologies of liver disease who underwent SG (n = 682) or GB (n = 355) were included. Trends of weight loss parameters and alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) at 0, 6 (in 90.4%), 12 (in 83.5%), and 24 months (in 67.1%) were compared using generalized estimating equations method.

Results

Overall, 1037 patients with mean age of 38.4 ± 11.2 and mean body mass index of 44.9 ± 6.2 kg/m2 were analyzed. Seventy-eight percent of patients had fatty liver by ultrasound. Both GB and SG patients lost significant weight, with GB patients having a higher percentage of excess weight loss at 24 months (80.1% vs. 75.9%, Pbetween-group = .008). SG patients showed more favorable trends in liver chemistries with significantly lower ALT at 12 months and AST and ALP levels at 6 and 12 months. However, the two groups were comparable at 24 months. Significantly more GB patients developed high ALT at 6 and high AST at 6 and 12 months. Undergoing GB was associated with smaller 0–12-month changes in ALT, AST, and ALP.

Conclusions

Bariatric surgery resulted in improvement in liver function parameters, with SG showing advantages over GB in the first postoperative year.

Keywords

Bariatric surgery Gastric bypass Nonalcoholic fatty liver disease Liver function tests Morbid obesity 

Notes

Acknowledgements

The authors would like to thank Dr. Mohammad Hassan Kalantar Motamedi for his editorial assistance and language editing of the manuscript.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was reviewed and approved by the institutional Human Research Review Committee (No. 2ECRIES 93/03/13) and written informed consent was obtained from all patients prior to enrollment.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524–30.  https://doi.org/10.1016/j.cgh.2011.03.020.CrossRefPubMedGoogle Scholar
  2. 2.
    Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328–57.  https://doi.org/10.1002/hep.29367.CrossRefPubMedGoogle Scholar
  3. 3.
    Leite NC, Salles GF, Araujo ALE, et al. Prevalence and associated factors of non-alcoholic fatty liver disease in patients with type-2 diabetes mellitus. Liver Int. 2009;29(1):113–9.  https://doi.org/10.1111/j.1478-3231.2008.01718.x.CrossRefPubMedGoogle Scholar
  4. 4.
    Targher G, Bertolini L, Padovani R, et al. Prevalence of nonalcoholic fatty liver disease and its association with cardiovascular disease among type 2 diabetic patients. Diabetes Care. 2007;30(5):1212–8.  https://doi.org/10.2337/dc06-2247.CrossRefPubMedGoogle Scholar
  5. 5.
    Balupuri S, Cheung AC, Mahawar KK, et al. Non-alcoholic fatty liver disease (NAFLD) and bariatric surgery. In: Agrawal S, editor. Obesity, bariatric and metabolic surgery: a practical guide. Cham: Springer International Publishing; 2016. p. 629–36.CrossRefGoogle Scholar
  6. 6.
    Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34(3):274–85.  https://doi.org/10.1111/j.1365-2036.2011.04724.x.CrossRefPubMedGoogle Scholar
  7. 7.
    Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413–9.CrossRefGoogle Scholar
  8. 8.
    Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112(1):18–35.  https://doi.org/10.1038/ajg.2016.517.CrossRefPubMedGoogle Scholar
  9. 9.
    Burza MA, Romeo S, Kotronen A, et al. Long-term effect of bariatric surgery on liver enzymes in the Swedish Obese Subjects (SOS) study. PLoS One. 2013;8(3):e60495.  https://doi.org/10.1371/journal.pone.0060495.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ooi GJ, Burton PR, Doyle L, et al. Effects of bariatric surgery on liver function tests in patients with nonalcoholic fatty liver disease. Obes Surg. 2017;27(6):1533–42.  https://doi.org/10.1007/s11695-016-2482-8.CrossRefPubMedGoogle Scholar
  11. 11.
    Bower G, Toma T, Harling L, et al. Bariatric surgery and non-alcoholic fatty liver disease: a systematic review of liver biochemistry and histology. Obes Surg. 2015;25(12):2280–9.  https://doi.org/10.1007/s11695-015-1691-x.CrossRefPubMedGoogle Scholar
  12. 12.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.  https://doi.org/10.1007/s11695-015-1657-z.CrossRefPubMedGoogle Scholar
  13. 13.
    Barzin M, Motamedi MAK, Serahati S, et al. Comparison of the effect of gastric bypass and sleeve gastrectomy on metabolic syndrome and its components in a cohort: Tehran Obesity Treatment Study (TOTS). Obes Surg. 2017;27(7):1697–704.  https://doi.org/10.1007/s11695-016-2526-0.CrossRefPubMedGoogle Scholar
  14. 14.
    Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2016;26(3):660–71.  https://doi.org/10.1007/s11695-016-2050-2.CrossRefPubMedGoogle Scholar
  15. 15.
    Mahawar KK. Another fatal outcome with a biliopancreatic limb length of 200 cm with one anastomosis gastric bypass. Obes Surg. 2017;27(7):1882–3.  https://doi.org/10.1007/s11695-017-2695-5.CrossRefPubMedGoogle Scholar
  16. 16.
    Barzin M, Hosseinpanah F, Motamedi MA, et al. Bariatric surgery for morbid obesity: Tehran Obesity Treatment Study (TOTS) rationale and study design. JMIR Res Protoc. 2016;5(1):e8.  https://doi.org/10.2196/resprot.5214.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Peterli R, Wolnerhanssen BK, Vetter D, et al. Laparoscopic sleeve gastrectomy versus Roux-Y-gastric bypass for morbid obesity-3-year outcomes of the prospective randomized Swiss Multicenter Bypass Or Sleeve Study (SM-BOSS). Ann Surg. 2017;265(3):466–73.  https://doi.org/10.1097/sla.0000000000001929.CrossRefPubMedGoogle Scholar
  18. 18.
    Aller R, Pacheco D, Izaola O, et al. Effect on liver enzymes of biliopancreatic diversion: 4 years of follow-up. Ann Nutr Metab. 2015;66(2–3):132–6.  https://doi.org/10.1159/000375506.CrossRefPubMedGoogle Scholar
  19. 19.
    Alizai PH, Wendl J, Roeth AA, et al. Functional liver recovery after bariatric surgery--a prospective cohort study with the LiMAx test. Obes Surg. 2015;25(11):2047–53.  https://doi.org/10.1007/s11695-015-1664-0.CrossRefPubMedGoogle Scholar
  20. 20.
    Motamedi MAK, Barzin M, Ebrahimi M, et al. Severe fatal protein malnutrition and liver failure in a morbidly obese patient after mini-gastric bypass surgery: case report. Int J Surg Case Rep. 2017;33(71–4.  https://doi.org/10.1016/j.ijscr.2017.02.033.CrossRefGoogle Scholar
  21. 21.
    Motamedi MAK, Rakhshani N, Khalaj A, et al. Biopsy-proven progressive fatty liver disease nine months post mini-gastric bypass surgery: a case study. Int J Surg Case Rep. 2017;39(168–71.  https://doi.org/10.1016/j.ijscr.2017.07.062.CrossRefGoogle Scholar
  22. 22.
    Tsai JH, Ferrell LD, Tan V, et al. Aggressive non-alcoholic steatohepatitis following rapid weight loss and/or malnutrition. Mod Pathol. 2017;30(6):834–42.  https://doi.org/10.1038/modpathol.2017.13.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Caiazzo R, Lassailly G, Leteurtre E, et al. Roux-en-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study. Ann Surg. 2014;260(5):893–8; discussion 98–9.  https://doi.org/10.1097/sla.0000000000000945.CrossRefPubMedGoogle Scholar
  24. 24.
    Kruschitz R, Luger M, Kienbacher C, et al. The effect of Roux-en-Y vs. omega-loop gastric bypass on liver, metabolic parameters, and weight loss. Obes Surg. 2016;26(9):2204–12.  https://doi.org/10.1007/s11695-016-2083-6.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Billeter AT, Senft J, Gotthardt D, et al. Combined non-alcoholic fatty liver disease and type 2 diabetes mellitus: sleeve gastrectomy or gastric bypass?-a controlled matched pair study of 34 patients. Obes Surg. 2016;26(8):1867–74.  https://doi.org/10.1007/s11695-015-2006-y.CrossRefPubMedGoogle Scholar
  26. 26.
    van Zutphen T, Ciapaite J, Bloks VW, et al. Malnutrition-associated liver steatosis and ATP depletion is caused by peroxisomal and mitochondrial dysfunction. J Hepatol. 2016;65(6):1198–208.  https://doi.org/10.1016/j.jhep.2016.05.046.CrossRefPubMedGoogle Scholar
  27. 27.
    Csak T, Ganz M, Pespisa J, et al. Fatty acid and endotoxin activate inflammasomes in mouse hepatocytes that release danger signals to stimulate immune cells. Hepatology. 2011;54(1):133–44.  https://doi.org/10.1002/hep.24341.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Verna EC, Berk PD. Role of fatty acids in the pathogenesis of obesity and fatty liver: impact of bariatric surgery. Semin Liver Dis. 2008;28(4):407–26.  https://doi.org/10.1055/s-0028-1091985.CrossRefPubMedGoogle Scholar
  29. 29.
    Lupoli R, Milone M, Di Minno A, et al. Haemostatic and fibrinolytic changes in obese subjects undergoing bariatric surgery: the effect of different surgical procedures. Blood Transfus. 2015;13(3):442–7.  https://doi.org/10.2450/2014.0183-14.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Kalinowski P, Paluszkiewicz R, Ziarkiewicz-Wroblewska B, et al. Liver function in patients with nonalcoholic fatty liver disease randomized to Roux-en-Y gastric bypass versus sleeve gastrectomy: a secondary analysis of a randomized clinical trial. Ann Surg. 2017;266(5):738–45.  https://doi.org/10.1097/SLA.0000000000002397.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Surgery at St. Paul’s HospitalUniversity of British ColumbiaVancouverCanada
  2. 2.Tehran Obesity Treatment Center, Department of Surgery, Faculty of MedicineShahed UniversityTehranIran
  3. 3.Obesity Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran

Personalised recommendations