S1174 Does Bariatric Surgery Decrease Risk of Cirrhosis and HCC?

Abstract

Introduction: Most patients with known Nonalcoholic Fatty Liver Disease (NAFLD) have metabolic syndrome. After undergoing weight loss surgery, many patients with NAFLD have rapid weight loss and subsequent correction of their metabolic syndrome leading to improvement in their liver disease. However, there is minimal data evaluating weight loss surgery in obese patients and the development of cirrhosis and HCC. Our aim is to determine whether there is a correlation between bariatric surgery and the development of cirrhosis and HCC in an obese population. Methods: We performed a retrospective analysis in the IBM Explorys database 5 (1999-2021), a pooled, national, de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals across the United States. Patient populations were identified using SNOMED and ICD codes. Obese patients (BMI greater than 30) who had bariatric surgery, including Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and Gastric Banding were identified. Patient data was evaluated to determine the number of patients who had developed cirrhosis or HCC, after at least 3 months of surgery. Additionally, patient data was analyzed for complications of cirrhosis, including development of ascites, esophageal varices, and hepatic encephalopathy. Odds ratio with 95% CI were calculated to assess risk of cirrhosis, cirrhosis complications, and HCC compared to a control cohort. Results: Weight loss surgery was associated with a decreased likelihood of developing HCC (OR 0.37, CI 0.24-0.58) and cirrhosis (OR 0.65, CI 0.60-0.70). However, there was an increased risk of having cirrhosis complications in patients with cirrhosis after having weight loss surgery. Increased cirrhosis complications included ascites (OR 26.30, CI 21.33–32.42), esophageal varices (OR 30.26, CI 24.55-37.31), and hepatic encephalopathy (OR 22.53, CI 16.91-30.01). Conclusion: Our data supports that weight loss is beneficial in NAFLD patients. Patients with obesity, who are unable to lose weight through lifestyle modifications, should be considered as candidates for bariatric surgery. We found that weight loss surgery was associated with reduced risk of developing cirrhosis and HCC. However, we found that once patients have developed cirrhosis, weight loss surgery may increase the risk of complications including ascites, esophageal varices, and hepatic encephalopathy. Future prospective studies are needed to validate these studies.Table 1