Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Non-Alcoholic Fatty Liver Disease: A 12-Month Follow-Up Study with Paired Liver Biopsies.

Julie Steen Pedersen,Flemming Bendtsen,Viggo Bjerregaard Kristiansen,Nicolai J Wewer Albrechtsen,Reza Rafiolsadat Serizawa,Marte Opseth Rygg,Lise Lotte Gluud,Sten Madsbad

doi:10.3390/jcm10173783

Abstract

Roux-en-Y gastric bypass (RYGB) improves, and can sometimes resolve, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) but data based on histological assessment for the efficacy of sleeve gastrectomy (SG) in resolving NAFLD are sparse. Consequently, we aimed to compare the efficacy of RYGB vs. SG on NAFLD 12 months after surgery. In a prospective cohort study, 40 patients with obesity underwent bariatric surgery (16 RYGB and 24 SG). During surgery, a liver biopsy was taken and repeated 12 months later. NAFLD severity was evaluated using the NAFLD Activity Score (NAS) and Kleiner Fibrosis score. RYGB and SG patients were comparable at baseline. Mean (standard deviation, SD) NAS was 3.3 (0.9) in RYGB and 3.1 (1.4) in SG (p = 0.560) with similar degrees of steatosis, inflammation, and ballooning. Two RYGB patients, and six SG patients, had NASH (p = 0.439). Twelve months after surgery, NAS was significantly and comparably (p = 0.241) reduced in both RYGB (−3.00 (95% CI −3.79–−2.21), p < 0.001) and SG (−2.25 (95% CI −2.92–−1.59), p < 0.001) patients. RYGB patients had significantly more reduced (p = 0.007) liver steatosis (−0.91 (95% CI −1.47–−1.2) than SG patients (−0.33 (95% CI −0.54–−0.13) and greater improvement in the plasma lipid profile. Fibrosis declined non-significantly. NASH was resolved in seven of eight patients without a worsening of their fibrosis. RYGB and SG have similar beneficial effects on NAS and NASH without the worsening of fibrosis. RYGB is associated with a more pronounced reduction in liver steatosis.

Highlights

Non-alcoholic fatty liver disease (NAFLD) is recognized as a major and escalating cause of chronic liver disease in most countries globally [1,2,3,4], where an estimated1-in-4 adults have NAFLD
The vast majority of data investigating the efficacy of bariatric surgery on NAFLD has been obtained from Roux-en-Y gastric bypass (RYGB) patients and, several studies have reported its beneficial effect on NAFLD and non-alcoholic steatohepatitis (NASH) [8,9,10,11], including fibrosis [8,10,12]
We investigated the effect of RYGB vs. sleeve gastrectomy (SG) using paired liver biopsies taken during the bariatric procedures and again 12 months later

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) is recognized as a major and escalating cause of chronic liver disease in most countries globally [1,2,3,4], where an estimated1-in-4 adults have NAFLD. The prevalence of NAFLD in patients with extreme obesity undergoing bariatric surgery has been reported to exceed 90%, with 25–35% having non-alcoholic steatohepatitis (NASH) [5,6]. The nearly comparable clinical outcomes in relation to weight loss and remission of T2DM are surprising given the marked anatomical differences between the two procedures [7]. The vast majority of data investigating the efficacy of bariatric surgery on NAFLD has been obtained from RYGB patients and, several studies have reported its beneficial effect on NAFLD and NASH [8,9,10,11], including fibrosis [8,10,12]

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