Bypass vs. Sleeve and Its Effects in Non-Alcoholic Fatty Liver Disease: What Is the Best Technique?

Goldoni, Marcos Bertozzi; Fontes, Paulo Roberto Ott; Guimarães, Marcela Menuci; Diedrich-Neto, João Alfredo; Nogueira, Tiele; Teixeira, Uirá Fernandes; Giacomazzi, Caroline Becker; Kiss, Guillermo; Pioner, Sérgio Ricardo; Rodrigues, Pablo Duarte

doi:10.1590/0102-672020200003e1549

Cited by 7 publications

(6 citation statements)

References 32 publications

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“…After 1,462 articles were excluded based on study title and abstract, 136 articles were selected for full text review, of which 31 articles met the final inclusion criteria (Figure 2). In total, five articles originated from the United States (36)(37)(38)(39)(40), six from Brazil (41)(42)(43)(44)(45)(46), four from France (18,(47)(48)(49), two from Poland (50,51), Australia (52,53) and Japan (54,55) respectively and one each from Denmark (56), Canada (57), Germany (58), Greece (59), India (60), Israel (61), Netherlands (62), Saudi Arabia (63), Taiwan (64) and Turkey (65). Of the 31 included articles, there were 20 single-arm and 11 doublearm studies.…”

Section: Summary Of Included Articlesmentioning

confidence: 99%

Foregut bypass vs. restrictive bariatric procedures for nonalcoholic fatty liver disease: a meta-analysis of 3,355 individuals

Lim¹,

Lin²,

Ng³

et al. 2023

Hepatobiliary Surg Nutr

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Background: Bariatric surgery represents an important treatment option for severely obese patients with nonalcoholic fatty liver disease (NAFLD). However, there remains inadequate data regarding the effects of different bariatric procedures on various NAFLD parameters, especially for histological outcomes. Thus, this meta-analysis aimed to compare the effects of restrictive bariatric procedures and foregut bypass on the metabolic, biochemical, and histological parameters for patients with NAFLD.Methods: Medline and Embase were searched for articles relating to bariatric procedures and NAFLD.Pairwise meta-analysis was conducted to compare efficacy of bariatric procedures pre-vs. post-procedure with subgroup analysis to further compare restrictive against foregut bypass procedures.Results: Thirty-one articles involving 3,355 patients who underwent restrictive bariatric procedures (n=1,460) and foregut bypass (n=1,895) were included. Both foregut bypass (P<0.01) and restrictive procedures (P=0.03) significantly increased odds of fibrosis resolution. Compared to restrictive procedures, foregut bypass resulted in a borderline non-significant decrease in fibrosis score (P=0.06) and significantly lower steatosis score (P<0.001). For metabolic parameters, foregut bypass significantly lowered body mass index (P=0.003) and low-density lipoprotein (P=0.008) compared to restrictive procedures. No significant differences were observed between both procedures for aspartate aminotransferase (P=0.17) and alkaline phosphatase (P=0.61). However, foregut bypass resulted in significantly lower gamma-glutamyl transferase than restrictive procedures (P=0.01) while restrictive procedures resulted in significantly lower alanine transaminase than foregut bypass (P=0.02).

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Section: Summary Of Included Articlesmentioning

confidence: 99%

Foregut bypass vs. restrictive bariatric procedures for nonalcoholic fatty liver disease: a meta-analysis of 3,355 individuals

Lim¹,

Lin²,

Ng³

et al. 2023

Hepatobiliary Surg Nutr

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“…This study found that RYBG provided better results according to NAFLD activity score compared with sleeve. 76 Studies on the effect of bariatric surgery on NAFLD stratified per procedure are summarized in Tables 1 – 3 .…”

Section: Therapeutic Approachesmentioning

confidence: 99%

Therapeutic approaches for non-alcoholic steatohepatitis

Gaal

Mertens

Francque

et al. 2021

Therapeutic Advances in Endocrinology

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Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have been reported as a novel worldwide epidemic, very often associated with obesity, metabolic syndrome, and type 2 diabetes. Both conditions have also been shown to be associated with a number of endocrine pathologies. Despite the epidemic, the complex pathophysiology and major complications, ranging from metabolic disturbances (diabetes and more) to cardiovascular disease, people with NASH are left with very few management options. The best and most approved therapeutic option is lifestyle intervention. Although pharmacotherapies based on pathophysiological background are in development, response rates appear modest, mainly for fibrosis treatment, which is the reason for lack of approved drug therapy. Previous drugs analyzed, such as pioglitazone and vitamin E, show weak efficacy. From different phase II trials, antidiabetic (injectable) drugs seem to be promising, both in mono- or bitherapy. Also, derivatives of peroxisome proliferator-activated receptors may have an interesting future, as well. For that reason, more focus should be given on prevention of this novel disease entity. In view of this booming epidemic, with a background of obesity and type 2 diabetes, and the important medical consequences, early recognition, prevention and intervention of NAFLD/NASH seems appropriate. In this review, we will focus on the different current and future therapeutic intervention options, taking into consideration the complex pathophysiology of this disease.

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“…Liver elastography has been a promising noninvasive method, and several previous studies have shown it to be a reliable and accurate test to assess hepatic steatosis and fibrosis 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Elastography in the Assessment of Reduction in Liver Steatosis and Fibrosis in the Early Postoperative Period After Bariatric Surgery

LIMA

GARCIA

Neves

et al. 2022

ABCD, arq. bras. cir. dig.

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BACKGROUND: Nonalcoholic hepatic steatosis is found in most obese patients and has a strong association with metabolic syndrome. The Roux-en-Y gastric bypass and the sleeve gastrectomy are the two techniques of bariatric surgery. Patients who underwent bariatric surgery have regression of nonalcoholic steatohepatitis due to a reduction in body mass index and changes in incretin hormones. AIMS: This study aimed to analyze the acuity of elastography in the regression of hepatic steatosis and fibrosis in obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy 2 months after surgery. METHODS: Patients in the preoperative period of bariatric surgery underwent an anthropometric evaluation and hepatic elastography to quantify fibrosis and hepatic steatosis. Two months after surgery, the same evaluation was performed again. RESULTS: All 17 patients who met the inclusion criteria participated in the study. Out of this, nine underwent sleeve gastrectomy, and eight underwent Roux-en-Y gastric bypass. The Roux-en-Y gastric bypass group had lower fibrosis levels postoperatively compared to preoperatively (p=0.029, p<0.05). As for steatosis, patients who underwent Roux-en-Y gastric bypass had lower postoperative values (p=0.01, p<0.05). There was also a reduction in fibrosis postoperatively in the sleeve gastrectomy group compared to preoperatively (p=0.037, p<0.05). CONCLUSIONS: Elastography accurately demonstrated decreased hepatic steatosis and fibrosis in the early postoperative period of bariatric surgery. Moreover, Roux-en-Y gastric bypass and sleeve gastrectomy are suitable surgical methods to improve hepatic steatosis and fibrosis within 2 months postoperatively.

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Bypass vs. Sleeve and Its Effects in Non-Alcoholic Fatty Liver Disease: What Is the Best Technique?

Cited by 7 publications

References 32 publications

Foregut bypass vs. restrictive bariatric procedures for nonalcoholic fatty liver disease: a meta-analysis of 3,355 individuals

Foregut bypass vs. restrictive bariatric procedures for nonalcoholic fatty liver disease: a meta-analysis of 3,355 individuals

Therapeutic approaches for non-alcoholic steatohepatitis

Accuracy of Elastography in the Assessment of Reduction in Liver Steatosis and Fibrosis in the Early Postoperative Period After Bariatric Surgery

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