Bariatric Surgery as an Efficient Treatment for Non-Alcoholic Fatty Liver Disease in a Prospective Study with 1-Year Follow-up

BariScan Study

Felix Nickel, Christian Tapking, Laura Benner, Janina Sollors, Adrian T. Billeter, Hannes G. Kenngott, Loay Bokhary, Mathias Schmid, Moritz von Frankenberg, Lars Fischer, Sebastian Mueller, Beat P. Müller-Stich

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Bariatric surgery gains attention as a potential treatment for non-alcoholic fatty liver disease (NAFLD). The present study aimed to evaluate improvement of NAFLD after the two most common bariatric procedures with validated non-invasive instruments. Material and Methods: N = 100 patients scheduled for laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) were included. NAFLD was evaluated preoperatively and postoperatively with liver stiffness measurement by transient elastography and laboratory-based fibrosis scores. Clinical data included body mass index (BMI), total weight loss (%TWL), excess weight loss (%EWL), age, gender, comorbidities, and the Edmonton obesity staging system (EOSS). Results: There were significant improvements of BMI, %TWL, %EWL, and EOSS after bariatric surgery. Liver stiffness was significantly improved from pre- to postoperative (12.9 ± 10.4 vs. 7.1 ± 3.7 kPa, p < 0.001) at median follow-up of 12.5 months. Additionally, there were significant improvements of liver fibrosis scores (aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio 0.8 ± 0.3 vs. 1.1 ± 0.4, p < 0.001; NAFLD fibrosis score − 1.0 ± 1.8 vs. − 1.7 ± 1.3, p < 0.001; APRI score 0.3 ± 0.2 vs. 0.3 ± 0.1, p = 0.009; BARD score 2.3 ± 1.2 vs. 2.8 ± 1.1, p = 0.008) and laboratory parameters (ALT, AST, and GGT). After adjustment for baseline liver stiffness, RYGB showed higher improvements than LSG, and there was no gender difference. Improvement of liver stiffness was not correlated to improvement of BMI, %TWL, %EWL, or EOSS. Conclusions: NAFLD seems to be improved by bariatric surgery as measured by validated non-invasive instruments. Furthermore, it appears that RYGB is more effective than LSG. No correlation could be detected between NAFLD and weight loss. The present study highlights the potential of bariatric surgery for successful treatment of NAFLD. Further research is required to understand the exact mechanisms.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalObesity Surgery
DOIs
StateAccepted/In press - Nov 9 2017
Externally publishedYes

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Bariatric Surgery
Prospective Studies
Gastric Bypass
Gastrectomy
Weight Loss
Body Mass Index
Obesity
Liver
Aspartate Aminotransferases
Alanine Transaminase
Liver Cirrhosis
Therapeutics
Bariatrics
Elasticity Imaging Techniques
Non-alcoholic Fatty Liver Disease
Comorbidity
Fibrosis
Research

Keywords

  • Bariatric surgery
  • Gastric bypass
  • Liver disease
  • Liver fibrosis
  • Metabolic surgery
  • Sleeve gastrectomy
  • Transient elastography

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Bariatric Surgery as an Efficient Treatment for Non-Alcoholic Fatty Liver Disease in a Prospective Study with 1-Year Follow-up : BariScan Study. / Nickel, Felix; Tapking, Christian; Benner, Laura; Sollors, Janina; Billeter, Adrian T.; Kenngott, Hannes G.; Bokhary, Loay; Schmid, Mathias; von Frankenberg, Moritz; Fischer, Lars; Mueller, Sebastian; Müller-Stich, Beat P.

In: Obesity Surgery, 09.11.2017, p. 1-9.

Research output: Contribution to journalArticle

Nickel, F, Tapking, C, Benner, L, Sollors, J, Billeter, AT, Kenngott, HG, Bokhary, L, Schmid, M, von Frankenberg, M, Fischer, L, Mueller, S & Müller-Stich, BP 2017, 'Bariatric Surgery as an Efficient Treatment for Non-Alcoholic Fatty Liver Disease in a Prospective Study with 1-Year Follow-up: BariScan Study', Obesity Surgery, pp. 1-9. https://doi.org/10.1007/s11695-017-3012-z
Nickel, Felix ; Tapking, Christian ; Benner, Laura ; Sollors, Janina ; Billeter, Adrian T. ; Kenngott, Hannes G. ; Bokhary, Loay ; Schmid, Mathias ; von Frankenberg, Moritz ; Fischer, Lars ; Mueller, Sebastian ; Müller-Stich, Beat P. / Bariatric Surgery as an Efficient Treatment for Non-Alcoholic Fatty Liver Disease in a Prospective Study with 1-Year Follow-up : BariScan Study. In: Obesity Surgery. 2017 ; pp. 1-9.
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abstract = "Background: Bariatric surgery gains attention as a potential treatment for non-alcoholic fatty liver disease (NAFLD). The present study aimed to evaluate improvement of NAFLD after the two most common bariatric procedures with validated non-invasive instruments. Material and Methods: N = 100 patients scheduled for laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) were included. NAFLD was evaluated preoperatively and postoperatively with liver stiffness measurement by transient elastography and laboratory-based fibrosis scores. Clinical data included body mass index (BMI), total weight loss ({\%}TWL), excess weight loss ({\%}EWL), age, gender, comorbidities, and the Edmonton obesity staging system (EOSS). Results: There were significant improvements of BMI, {\%}TWL, {\%}EWL, and EOSS after bariatric surgery. Liver stiffness was significantly improved from pre- to postoperative (12.9 ± 10.4 vs. 7.1 ± 3.7 kPa, p < 0.001) at median follow-up of 12.5 months. Additionally, there were significant improvements of liver fibrosis scores (aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio 0.8 ± 0.3 vs. 1.1 ± 0.4, p < 0.001; NAFLD fibrosis score − 1.0 ± 1.8 vs. − 1.7 ± 1.3, p < 0.001; APRI score 0.3 ± 0.2 vs. 0.3 ± 0.1, p = 0.009; BARD score 2.3 ± 1.2 vs. 2.8 ± 1.1, p = 0.008) and laboratory parameters (ALT, AST, and GGT). After adjustment for baseline liver stiffness, RYGB showed higher improvements than LSG, and there was no gender difference. Improvement of liver stiffness was not correlated to improvement of BMI, {\%}TWL, {\%}EWL, or EOSS. Conclusions: NAFLD seems to be improved by bariatric surgery as measured by validated non-invasive instruments. Furthermore, it appears that RYGB is more effective than LSG. No correlation could be detected between NAFLD and weight loss. The present study highlights the potential of bariatric surgery for successful treatment of NAFLD. Further research is required to understand the exact mechanisms.",
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author = "Felix Nickel and Christian Tapking and Laura Benner and Janina Sollors and Billeter, {Adrian T.} and Kenngott, {Hannes G.} and Loay Bokhary and Mathias Schmid and {von Frankenberg}, Moritz and Lars Fischer and Sebastian Mueller and M{\"u}ller-Stich, {Beat P.}",
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AU - Tapking, Christian

AU - Benner, Laura

AU - Sollors, Janina

AU - Billeter, Adrian T.

AU - Kenngott, Hannes G.

AU - Bokhary, Loay

AU - Schmid, Mathias

AU - von Frankenberg, Moritz

AU - Fischer, Lars

AU - Mueller, Sebastian

AU - Müller-Stich, Beat P.

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N2 - Background: Bariatric surgery gains attention as a potential treatment for non-alcoholic fatty liver disease (NAFLD). The present study aimed to evaluate improvement of NAFLD after the two most common bariatric procedures with validated non-invasive instruments. Material and Methods: N = 100 patients scheduled for laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) were included. NAFLD was evaluated preoperatively and postoperatively with liver stiffness measurement by transient elastography and laboratory-based fibrosis scores. Clinical data included body mass index (BMI), total weight loss (%TWL), excess weight loss (%EWL), age, gender, comorbidities, and the Edmonton obesity staging system (EOSS). Results: There were significant improvements of BMI, %TWL, %EWL, and EOSS after bariatric surgery. Liver stiffness was significantly improved from pre- to postoperative (12.9 ± 10.4 vs. 7.1 ± 3.7 kPa, p < 0.001) at median follow-up of 12.5 months. Additionally, there were significant improvements of liver fibrosis scores (aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio 0.8 ± 0.3 vs. 1.1 ± 0.4, p < 0.001; NAFLD fibrosis score − 1.0 ± 1.8 vs. − 1.7 ± 1.3, p < 0.001; APRI score 0.3 ± 0.2 vs. 0.3 ± 0.1, p = 0.009; BARD score 2.3 ± 1.2 vs. 2.8 ± 1.1, p = 0.008) and laboratory parameters (ALT, AST, and GGT). After adjustment for baseline liver stiffness, RYGB showed higher improvements than LSG, and there was no gender difference. Improvement of liver stiffness was not correlated to improvement of BMI, %TWL, %EWL, or EOSS. Conclusions: NAFLD seems to be improved by bariatric surgery as measured by validated non-invasive instruments. Furthermore, it appears that RYGB is more effective than LSG. No correlation could be detected between NAFLD and weight loss. The present study highlights the potential of bariatric surgery for successful treatment of NAFLD. Further research is required to understand the exact mechanisms.

AB - Background: Bariatric surgery gains attention as a potential treatment for non-alcoholic fatty liver disease (NAFLD). The present study aimed to evaluate improvement of NAFLD after the two most common bariatric procedures with validated non-invasive instruments. Material and Methods: N = 100 patients scheduled for laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) were included. NAFLD was evaluated preoperatively and postoperatively with liver stiffness measurement by transient elastography and laboratory-based fibrosis scores. Clinical data included body mass index (BMI), total weight loss (%TWL), excess weight loss (%EWL), age, gender, comorbidities, and the Edmonton obesity staging system (EOSS). Results: There were significant improvements of BMI, %TWL, %EWL, and EOSS after bariatric surgery. Liver stiffness was significantly improved from pre- to postoperative (12.9 ± 10.4 vs. 7.1 ± 3.7 kPa, p < 0.001) at median follow-up of 12.5 months. Additionally, there were significant improvements of liver fibrosis scores (aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio 0.8 ± 0.3 vs. 1.1 ± 0.4, p < 0.001; NAFLD fibrosis score − 1.0 ± 1.8 vs. − 1.7 ± 1.3, p < 0.001; APRI score 0.3 ± 0.2 vs. 0.3 ± 0.1, p = 0.009; BARD score 2.3 ± 1.2 vs. 2.8 ± 1.1, p = 0.008) and laboratory parameters (ALT, AST, and GGT). After adjustment for baseline liver stiffness, RYGB showed higher improvements than LSG, and there was no gender difference. Improvement of liver stiffness was not correlated to improvement of BMI, %TWL, %EWL, or EOSS. Conclusions: NAFLD seems to be improved by bariatric surgery as measured by validated non-invasive instruments. Furthermore, it appears that RYGB is more effective than LSG. No correlation could be detected between NAFLD and weight loss. The present study highlights the potential of bariatric surgery for successful treatment of NAFLD. Further research is required to understand the exact mechanisms.

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KW - Gastric bypass

KW - Liver disease

KW - Liver fibrosis

KW - Metabolic surgery

KW - Sleeve gastrectomy

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