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Impact of sleeve gastrectomy and Roux-en-Y gastric bypass on biopsy-proven non-alcoholic fatty liver disease

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Non-alcoholic fatty liver disease (NAFLD)/steatohepatitis (NASH) is the hepatic manifestation of metabolic syndrome. Our aim was to study the long-term effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on NAFLD/NASH.

Methods

Between 2008 and 2015, 3813 patients had an intraoperative liver biopsy performed at the time of primary RYGB and SG at a single academic center. Utilizing strict inclusion criteria, 487 patients with biopsy-proven NAFLD who had abnormal alanine aminotransferase (ALT) or aspartate aminotransferase (AST) values (≥ 40 IU/L) at baseline were identified. Matching of SG to RYGB patients (1:4) was performed via logistic regression and propensity scores adjusting for clinical and liver histological characteristics. Changes in liver function tests (LFTs) at least 1 year after surgery were compared to baseline values and between the surgical groups.

Results

A total of 310 (weighted) patients (SG n = 62, and RYGB n = 248) with a median follow-up time of 4 years (range, 1–10) were included in the analysis. The distribution of covariates was well-balanced after propensity matching. In 84% of patients, LFT values normalized after bariatric surgery at the last follow-up time. The proportions of patients having normalized LFT values did not differ significantly between the SG and RYGB groups (82% vs. 84%, p = 0.66). The AST decreased from (SG: 49.1 ± 21.5 vs. RYGB: 49.3 ± 22.0, p = 0.93) at baseline to (SG: 28.0 ± 16.5 vs. RYGB: 26.5 ± 15.5, p = 0.33) at the last follow-up. Similarly, a significant reduction in ALT values from (SG: 61.7 ± 30.0 vs. RYGB 59.4 ± 24.9, p = 0.75) at baseline to (SG: 27.2 ± 21.5 vs. RYGB: 26.1 ± 19.2, p = 0.52) at the last follow-up was observed.

Conclusions

In patients with biopsy-proven NAFLD/NASH, abnormal LFTs are normalized in most SG and RYGB patients by the end of the first postoperative year and remain normal until the last follow-up. This study also suggests that both bariatric procedures are similarly effective in improving liver function.

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Funding

RV was supported by a Fellowship of the Fulbright Commission and a Fellowship of the Belgian American Educational Foundation.

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Authors and Affiliations

  1. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA

    Deepa V. Cherla, Noe A. Rodriguez, Roman Vangoitsenhoven, Stacy A. Brethauer, Philip R. Schauer & Ali Aminian

  2. Department of General Surgery, Florida Atlantic University, Boca Raton, FL, USA

    Noe A. Rodriguez

  3. Department of Endocrinology, UZLeuven, Leuven, Belgium

    Roman Vangoitsenhoven

  4. Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA

    Tavankit Singh, Neal Mehta & Arthur J. McCullough

  5. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Stacy A. Brethauer

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  1. Deepa V. Cherla
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Correspondence to Ali Aminian.

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Disclosures

Drs. Deepa V Cherla, Noe A Rodriguez, Roman Vangoitsenhoven, Tavankit Singh, Neal Mehta, Arthur J McCullough, Stacy A Brethauer, Philip R Schauer, and Ali Aminian have no conflicts of interest or financial ties to disclose.

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Cherla, D.V., Rodriguez, N.A., Vangoitsenhoven, R. et al. Impact of sleeve gastrectomy and Roux-en-Y gastric bypass on biopsy-proven non-alcoholic fatty liver disease. Surg Endosc 34, 2266–2272 (2020). https://doi.org/10.1007/s00464-019-07017-0

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