Long-term effects of one-anastomosis gastric bypass on liver histopathology in NAFLD cases: a prospective study

Salman, Mohamed Abdalla; Salman, Ahmed; Omar, Haitham S. E.; Abdelsalam, Ahmed; Mostafa, Mohamed Saber; Tourky, Mohamed; Sultan, Audrey; Elshafey, Mohammed Hassan; Abdelaty, Walid Rafat; Salem, Abdoh; Khaliel, Osama Osman; Elshafey, Hossam E; Atallah, Mohammad; Shaaban, Hossam El‐Din; Yousef, Mohammad S.; Nafea, Mohammed A.

doi:10.1007/s00464-020-07725-y

Cited by 13 publications

(13 citation statements)

References 32 publications

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“…There is a discrepancy between our results, showing abnormal ALT levels in a relatively large fraction of patients that underwent bypass surgery, and the histological findings showing an improvement in NASH without worsening in fibrosis and improvement in histological scores after bypass surgery [ 3 , 8 , 17 , 30 , 31 , 32 ]. There are a few reports on the development of acute liver failure following bariatric surgery, mostly bypass surgery [ 2 , 37 , 38 , 39 , 40 ], but these cases are rare compared with the rates of abnormal ALT levels we report here.…”

Section: Discussioncontrasting

confidence: 95%

“…Patients that underwent SG or bypass surgery had similar pre-operative characteristics, but SG patients had lower levels of ALT and AST two years after surgery, and a lower incidence of new onset abnormal ALT levels. Notably, histological and imaging studies showed that bariatric surgery, and in particular bypass surgery, are associated with an improvement in NAFLD, NASH and non-worsening of liver fibrosis [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…While all bariatric surgery generally improves obesity, different types of surgery differ in resulting anatomy, potential mechanisms of action [ 12 ] and outcome: bypass surgery such as Roux en Y Gastric Bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) usually induce greater weight-loss and reduction in glycated hemoglobin (A1C) than Sleeve Gastrectomy (SG) [ 13 , 14 , 15 , 16 ] and are therefore expected to be superior in improving the outcomes of NAFLD. RYGB was shown to be superior to gastric banding, in long-term histological studies in improving NASH [ 3 , 8 ] and OAGB shows great promise in improving NASH in histological studies [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Sleeve Gastrectomy Is Associated with a Greater Reduction in Plasma Liver Enzymes Than Bypass Surgeries—A Registry-Based Two-Year Follow-Up Analysis

Azulai

Grinbaum

Beglaibter

et al. 2021

JCM

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Bariatric surgeries may lead to an improvement in metabolic fatty liver disease, and a reduction in the levels of the hepatic enzyme Alanine Aminotransferase (ALT). We compared the effects of Sleeve Gastrectomy (SG), Roux en Y Gastric Bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) on the levels of ALT by analysis of two-year follow-up data from 4980 patients in the Israeli Bariatric Registry that included laboratory tests and demographic information. Pre-operative characteristics of patients, and particularly levels of liver enzymes, were similar across surgery types. Regression modeling and retrospective matching showed that SG was superior to RYGB and OAGB in reducing ALT levels, and in reducing the fraction of patients with abnormally high ALT levels. Two-year post-surgery, an increase in ALT levels from normal to abnormal levels was observed in 5% of SG patients, and in 18% and 23% of RYGB and OAGB patients. In conclusion, SG leads to a greater reduction in ALT levels compared with bypass surgeries and a lower incidence of post-surgical elevation of ALT levels. Further studies are required to identify the cause for the rise in liver enzymes, and to determine whether ALT levels correlate with liver pathology especially following bariatric surgery.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sleeve Gastrectomy Is Associated with a Greater Reduction in Plasma Liver Enzymes Than Bypass Surgeries—A Registry-Based Two-Year Follow-Up Analysis

Azulai

Grinbaum

Beglaibter

et al. 2021

JCM

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“…The surgical trials comprised of ten prospective cohort trials (39)(40)(41)(42)(43)(44)(45)(46)(47)(48) and two with comparative (49,50) designs 2). The twelve non-surgical studies comprised of five twoarmed (13,(16)(17)(18)36), one four-armed (12), five threearmed placebo-controlled trials (14,15,19,35,38), and one three-armed randomized trial (37).…”

Section: Descriptive Characteristics and Baseline Liver Histologymentioning

confidence: 99%

Comparative effectiveness of medical treatment vs. metabolic surgery for histologically proven non-alcoholic steatohepatitis and fibrosis: a matched network meta-analysis

Billeter¹,

Reiners²,

Seide³

et al. 2022

Hepatobiliary Surg Nutr

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Importance: This network meta-analysis compares for the first time the effectiveness of different therapies for non-alcoholic steatohepatitis (NASH) using a novel statistical approach.Objective: NASH comprises a major healthcare problem affecting up to 30% of patients with obesity and the associated risk for cardiovascular and liver-related mortality. Several new drugs for NASH-treatment are currently investigated. No study thus far directly compared surgical and non-surgical therapies for NASH.Data Sources: PubMed, CENTRAL and Web of Science were searched without restriction of time or language using a validated search strategy.Study Selection: Studies investigating therapies for NASH in adults with liver biopsies at baseline and after at least 12 months were selected. Patients with liver cirrhosis were excluded. Data Extraction and Synthesis:The study was conducted according to the PRISMA guidelines for network meta-analysis. Out of 7,913 studies, twelve randomized non-surgical studies and twelve nonrandomized surgical trials were included. Risk of bias was assessed with ROB-2 and ROBINS-I-tools. A novel method for population-adjusted indirect comparison to include and compare single-arm trials was applied.Main Outcomes and Measures: Main outcomes were NASH-resolution and improvement of fibrosis.Results: Twenty-four trials (12 non-surgical and 12 surgical) were included. NASH-resolution after nonsurgical intervention was 29% (95% CI: 23-40%) and 79% (95% CI: 72-88%) after surgery. The network meta-analysis showed that surgery had a higher chance of NASH-resolution than medication (OR 2.68, 95% CI: 1.44-4.97) while drug treatment was superior to placebo (OR 2.24, 95% CI: 1.55-3.24). Surgery (OR 2.18, 95% CI: 1.34-3.56) and medication (OR 1.79, 95% CI: 1.39-2.31) were equally effective to treat fibrosis compared to placebo without difference between them. The results did not change when only new drugs specifically developed for the treatment of NASH were included.Conclusions and Relevance for Meta-analysis: Metabolic surgery has a higher effectiveness for NASH-therapy than medical therapy while both were equally effective regarding improvement of fibrosis.Trials directly comparing surgery with medication must be urgently conducted. Patients with NASH should be informed about surgical treatment options.

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“…A recent prospective study demonstrated the bariatric surgery, namely one-anastomosis gastric bypass, led to a significant decrease in the grades of fatty infiltration, cell ballooning, lobular inflammatory changes and total NAS at 15 mo postoperatively[ 82 ]. More specifically, the histological features of NASH disappeared in 41.7% of NASH cases and in 50.0% of borderline NASH cases[ 82 ]. Another recently published prospective study supports these findings by demonstrating histological resolution of NASH with no worsening of fibrosis in 84.4% of the patients[ 83 ].…”

Section: Surgical Managementmentioning

confidence: 99%

Metabolic syndrome and liver disease in the era of bariatric surgery: What you need to know!

Ziogas

Zapsalis

Giannis

et al. 2020

WJH

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Metabolic syndrome (MS) is defined as the constellation of obesity, insulin resistance, high serum triglycerides, low high-density lipoprotein cholesterol, and high blood pressure. It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare, cost, and quality of life associated consequences. MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease. Conservative treatment, which includes diet, exercise, and antidiabetic agents, is the mainstay of treatment, but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations. Bariatric surgery has recently emerged as an appropriate alternative treatment with promising long-term results. Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates. Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with non-alcoholic steatohepatitis has increased more than fivefold over the past 15 years. In this review, we summarize current state of evidence on the surgical treatment of MS.

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Long-term effects of one-anastomosis gastric bypass on liver histopathology in NAFLD cases: a prospective study

Cited by 13 publications

References 32 publications

Sleeve Gastrectomy Is Associated with a Greater Reduction in Plasma Liver Enzymes Than Bypass Surgeries—A Registry-Based Two-Year Follow-Up Analysis

Sleeve Gastrectomy Is Associated with a Greater Reduction in Plasma Liver Enzymes Than Bypass Surgeries—A Registry-Based Two-Year Follow-Up Analysis

Comparative effectiveness of medical treatment vs. metabolic surgery for histologically proven non-alcoholic steatohepatitis and fibrosis: a matched network meta-analysis

Metabolic syndrome and liver disease in the era of bariatric surgery: What you need to know!

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