Obesity Surgery

, Volume 28, Issue 5, pp 1342–1350 | Cite as

Bariatric Surgery as an Efficient Treatment for Non-Alcoholic Fatty Liver Disease in a Prospective Study with 1-Year Follow-up

BariScan Study
  • Felix Nickel
  • Christian Tapking
  • Laura Benner
  • Janina Sollors
  • Adrian T. Billeter
  • Hannes G. Kenngott
  • Loay Bokhary
  • Mathias Schmid
  • Moritz von Frankenberg
  • Lars Fischer
  • Sebastian Mueller
  • Beat P. Müller-Stich
Original Contributions



Bariatric surgery gains attention as a potential treatment for non-alcoholic fatty liver disease (NAFLD). The present study aimed to evaluate improvement of NAFLD after the two most common bariatric procedures with validated non-invasive instruments.

Material and Methods

N = 100 patients scheduled for laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) were included. NAFLD was evaluated preoperatively and postoperatively with liver stiffness measurement by transient elastography and laboratory-based fibrosis scores. Clinical data included body mass index (BMI), total weight loss (%TWL), excess weight loss (%EWL), age, gender, comorbidities, and the Edmonton obesity staging system (EOSS).


There were significant improvements of BMI, %TWL, %EWL, and EOSS after bariatric surgery. Liver stiffness was significantly improved from pre- to postoperative (12.9 ± 10.4 vs. 7.1 ± 3.7 kPa, p < 0.001) at median follow-up of 12.5 months. Additionally, there were significant improvements of liver fibrosis scores (aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio 0.8 ± 0.3 vs. 1.1 ± 0.4, p < 0.001; NAFLD fibrosis score − 1.0 ± 1.8 vs. − 1.7 ± 1.3, p < 0.001; APRI score 0.3 ± 0.2 vs. 0.3 ± 0.1, p = 0.009; BARD score 2.3 ± 1.2 vs. 2.8 ± 1.1, p = 0.008) and laboratory parameters (ALT, AST, and GGT). After adjustment for baseline liver stiffness, RYGB showed higher improvements than LSG, and there was no gender difference. Improvement of liver stiffness was not correlated to improvement of BMI, %TWL, %EWL, or EOSS.


NAFLD seems to be improved by bariatric surgery as measured by validated non-invasive instruments. Furthermore, it appears that RYGB is more effective than LSG. No correlation could be detected between NAFLD and weight loss. The present study highlights the potential of bariatric surgery for successful treatment of NAFLD. Further research is required to understand the exact mechanisms.


Transient elastography Bariatric surgery Metabolic surgery Liver disease Liver fibrosis Gastric bypass Sleeve gastrectomy 



We would like to thank Carly R. Garrow for proofreading the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the present study.

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. Ethical approval was obtained from the local ethics committee (S-181/2009, S-618/2011, S-500/2012 and S-629/2013).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Felix Nickel
    • 1
  • Christian Tapking
    • 1
  • Laura Benner
    • 3
  • Janina Sollors
    • 2
  • Adrian T. Billeter
    • 1
  • Hannes G. Kenngott
    • 1
  • Loay Bokhary
    • 1
  • Mathias Schmid
    • 1
  • Moritz von Frankenberg
    • 1
  • Lars Fischer
    • 1
  • Sebastian Mueller
    • 2
  • Beat P. Müller-Stich
    • 1
  1. 1.Department of General, Visceral and Transplant SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of Internal MedicineSalem HospitalHeidelbergGermany
  3. 3.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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