Deepa V Cherla, MD1, Noe A Rodriguez, MD2, Maryna Chumakova-Orin, MD1, Tavankit Singh1, Arthur J Mccullough1, Stacy A Brethauer1, Philip R Schauer1, Ali Aminian, MD1. 1Cleveland Clinic Foundation, 2Florida Atlantic University
INTRODUCTION: Our aim was to study the long-term effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass on Non-alcoholic fatty liver disease (NAFLD)/steatohepatitis (NASH). NAFLD/NASH is considered the hepatic manifestation of metabolic syndrome and is closely associated with obesity, insulin resistance, diabetes, and dyslipidemia.
METHODS: During an eight year period (2008-2015), 3,813 patients had simultaneous liver biopsy at the time of primary RYGB and SG at an academic center. Utilizing very strict inclusion criteria, we identified 487 patients with biopsy-proven NAFLD or NASH who had abnormal alanine aminotransferase (ALT) or aspartate aminotransferase (AST) values (≥40 IU/L) at baseline. Matching of SG to RYGB patients (1:4 ratio) was performed via logistic regression and propensity scores adjusting for age, gender, BMI, presence of diabetes, NAFLD activity score (NAS), presence of NASH, and fibrosis score. Changes in liver function tests (LFTs) at least one year after surgery were compared to baseline values and between the surgical groups.
RESULTS: A total of 310 (weighted) patients (SG n=62, and RYGB n=248) with a median follow-up time of 4 years (range, 1-10) were included in the analysis. The distribution of covariates was well-balanced after propensity matching. The NAS (3.7±1.5 versus 3.6±1.5, p=0.68), presence of NASH (65% versus 59%, p=0.42), and fibrosis score (1.1±1.0 versus 1.1±1.2, p=0.92) were comparable between SG and RYGB groups, respectively. In a majority of patients, LFT values normalized after bariatric surgery (83% at 1-year and 84% at the last follow-up time). The proportions of patients having normalized LFT values did not differ significantly between the SG and RYGB groups at either the 1-year or long-term time points. The AST decreased from (SG: 49.1±21.5 versus RYGB 49.3±22.0, p=0.92) at baseline to (SG: 26.8±10.2 versus RYGB: 24.9±9.8, p=0.27) at 1-year and to (SG: 28.0±16.5 versus RYGB: 26.5±15.5, p=0.33) at the last follow-up. Similarly, a significant reduction in ALT values from (SG: 61.7±30.0 versus RYGB 59.4±24.9, p=0.75) at baseline to (SG: 28.5±15.8 versus RYGB: 26.6±14.3, p=0.49) at 1-year and to (SG: 27.2±21.5 versus RYGB: 26.1±19.2, p=0.52) at the last follow-up was observed.
CONCLUSIONS: In patients with biopsy-proven NAFLD/NASH, abnormal LFTs are normalized in the large majority of SG and RYGB patients by the end of the first year post-surgery. This study, which is the largest reported comparative series, also provides evidence that, after controlling for baseline clinical and biopsy-proven pathological variables, both procedures are similarly effective in improving liver function.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95353
Program Number: S124
Presentation Session: Bariatric IV – Quality and Outcomes
Presentation Type: Podium
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