NAFLD: an indication for sleeve gastrectomy?

  • Esquivel CM & al.
  • Obes Surg
  • 18 Aug 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Sleeve gastrectomy (SG) significantly improves nonalcoholic fatty liver disease (NAFLD) at 1 year postsurgery.

Why this matters

  • Few data exist regarding the effect of this popular bariatric procedure on NAFLD evolution.
  • Authors comment: “SG could avoid a liver transplant in obese patients with NAFLD, and thus NAFLD should be included as a formal indication for bariatric surgery.”

Study design

  • Argentinian study of 63 obese patients (mean age, 40±10 years; 65% female) undergoing laparoscopic SG with intraoperative liver biopsy.
  • Repeat biopsy was performed in 43 patients after 1 year; the remaining 20 underwent laboratory testing only.
  • Funding: None disclosed.

Key results

  • At baseline, 90.5% of patients had steatosis (G1, 54%; G2, 27%; G3, 9.5%), and 50.8% had some degree of steatohepatitis (G1, 42.9%; G2, 4.8%; G3, 3.1%).
  • 39.7% had steatosis + steatohepatitis.
  • At 1 year post-SG:
    • Mean weight loss, 32%±6% (P<.0001>
    • Lipid panels: improved high-density lipoprotein cholesterol (P=.027) and triglycerides (P=.001).
    • Liver function tests improved (all P<.0001>
    • Glycemia, HbA1c, oral glucose tolerance test, insulin level, and homeostatic model assessment of insulin resistance (HOMA-IR) all improved (all P<.0001>
  • Of 43 patients with 1-year biopsy data, 100% had resolution or improvement of steatosis (P<.001 or steatohepatitis grade.>

Limitations

  • Monocentric design; small sample size.

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