Prospective evaluation of hepatic steatosis and fibrosis after one anastomosis gastric bypass using transient elastography

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among individuals with severe obesity and is closely associated with insulin resistance and metabolic dysfunction. Although metabolic and bariatric surgery has demonstrated favorable hepatic effects, prospective data evaluating liver-related outcomes following one-anastomosis gastric bypass (OAGB) remain limited. This prospective cohort study included adults with severe obesity undergoing OAGB between February 2024 and January 2025 at a tertiary academic center. Hepatic steatosis and fibrosis were assessed preoperatively and 6 months postoperatively using ultrasonography and transient elastography, including liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). Metabolic, biochemical, and anthropometric parameters were also evaluated using paired comparisons. A total of 85 patients were included, of whom 82 completed the 6-month transient elastography assessment. The mean age was 44.34 ± 10.23 years, and 82.4% were female. At 6 months, patients achieved a mean total body weight loss of 29.64%. Significant improvements were observed in liver-related parameters, including reductions in ALT ( P < 0.01), AST ( P = 0.02), LSM ( P < 0.01), and CAP ( P < 0.01). Significant improvements were also observed in fasting blood glucose ( P < 0.01), HbA1c ( P < 0.01), triglycerides ( P < 0.01), total cholesterol ( P < 0.01), and LDL cholesterol ( P = 0.01). OAGB was associated with significant short-term improvement in hepatic steatosis, liver stiffness, liver enzymes, glycemic control, and lipid profile among patients with severe obesity. These findings support the potential role of OAGB as a metabolic and hepatic therapeutic intervention for MASLD.