Abstract
Bariatric–metabolic surgery improves non-alcoholic steatohepatitis (NASH) in people with obesity and should be considered as an alternative to lifestyle intervention plus best medical care, according to the BRAVES trial. Ornella Verrastro and colleagues randomly assigned patients with obesity and histologically confirmed NASH, irrespective of their type 2 diabetes status, to receive either lifestyle modification plus best medical care (n=96), Roux-en-Y gastric bypass (n=96), or sleeve gastrectomy (n=96). In the intention-to-treat analysis, at 1-year follow-up, the primary endpoint of histological resolution of NASH without worsening of fibrosis was met by 54 (56%) patients in the Roux-en-Y gastric bypass group and 55 (57%) in the sleeve gastrectomy group compared with 15 (16%) in the lifestyle modification group—significantly higher with bariatric–metabolic surgery than with lifestyle modification (p<0·0001). Severe adverse events occurred in ten (6%) patients across the surgery groups; however, all events were resolved with medical or endoscopic management.
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