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Surg Obes Relat Dis. 2018 Oct;14(10):1607-1616. doi: 10.1016/j.soard.2018.07.012. Epub 2018 Jul 24.

Histologic improvement of NAFLD in patients with obesity after bariatric surgery based on standardized NAS (NAFLD activity score).

Author information

1
Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany. Electronic address: witigo.vonschoenfels@uksh.de.
2
Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
3
Institute of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany.
4
Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany.
5
Medical Department 1, University Hospital Dresden, Technical University Dresden, Dresden, Germany.

Abstract

BACKGROUND:

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in industrialized countries. Nonalcoholic steatohepatitis is the fastest growing cause for liver failure. Bariatric surgery represents a treatment option for NAFLD with an established effect on liver histology.

OBJECTIVES:

We aimed to assess the impact of bariatric surgery on standardized liver histology using the NAFLD activity score.

SETTING:

Retrospective comparison of metabolic data before and after bariatric surgery and comparison of sleeve gastrectomy and Roux-en-Y gastric bypass. The study was performed in an academic center, the university hospital Schleswig-Holstein in Kiel, Germany.

METHODS:

Between 2009 and 2012, bariatric surgery was performed in 257 patients according to the national guidelines, and a liver biopsy was obtained in 150 of these patients during surgery. A follow-up biopsy was available in 53 of these patients at a median of 192 days. Liver histology was analyzed using the NAFLD activity score. In this subgroup of 53 patients an analysis of the metabolic improvement after bariatric surgery and a comparative analysis between the 2 different operative procedures was performed.

RESULTS:

The study cohort showed improvement of preoperative pathologic liver histology findings after operative procedures took place. Both surgery methods improved the NAFLD activity score significantly, all improvement -2.0 (confidence interval -2.5 to -1.0; P < .001); Roux-en-Y gastric bypass, improvement -1.0 (confidence interval -2.0 to -.0; P = .038); sleeve gastrectomy, improvement -2.5 (confidence interval -3.5 to -1.5; P < .001). No differences were found with regard to histologic recovery between gastric bypass and sleeve gastrectomy (P = .22).

CONCLUSIONS:

Bariatric surgery significantly improves NAFLD.

KEYWORDS:

NAFLD; NASH; RYGB; SG

PMID:
30146425
DOI:
10.1016/j.soard.2018.07.012
[Indexed for MEDLINE]

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