Key result
Laparoscopic sleeve gastrectomy reduced the prevalence of definite non-alcoholic steatohepatitis from 53% at baseline to 11% at 18 months post-surgery.
Why the study?
Bariatric surgery is a valid treatment for non-alcoholic fatty liver disease, but the prospective impact of laparoscopic sleeve gastrectomy on liver histopathology and specific adipokine levels warranted evaluation.
Does laparoscopic sleeve gastrectomy improve liver histopathology and serum adipokine levels in patients with non-alcoholic fatty liver disease?
Cohort (n=81)
Does laparoscopic sleeve gastrectomy improve liver histopathology and serum adipokine levels in patients with non-alcoholic fatty liver disease?
Absolute Event Rate: 11% vs 53%
Weight loss after laparoscopic sleeve gastrectomy significantly improves liver histopathology, metabolic parameters, and adipokine profiles in patients with non-alcoholic fatty liver disease.
LSG-linked weight loss improves NAFLD histology and adipokines; leaves open whether benefits alter hard outcomes in randomized trials.
BACKGROUND & AIM: Bariatric surgery is a valid treatment option for persons with non-alcoholic fatty liver disease. This study prospectively examined the impact of laparoscopic sleeve gastrectomy (LSG) on liver histopathology, and blood levels of adiponectin, leptin, resistin, and pre-B cell enhancing factor/Nampt/visfatin. PATIENTS & METHODS: In 81 patients with non-alcoholic fatty liver disease who underwent LSG, paired liver biopsies and blood specimens were obtained before and 18 months after LSG. Differences between preoperative and 18 months postoperative data were tested by paired Student's t-test or Wilcoxon rank test as appropriate. RESULTS: At follow up, there was a significant improvement in biochemical markers for glucose homeostasis, including fasting glucose, HbA1c, insulin levels, and homeostatic model assessment index. Postoperative liver function tests, namely serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase level, showed a significant improvement compared to before weight loss. The number of patients who had definite, borderline, or no non-alcoholic steatohepatitis was 43 (53%), 27 (33%), and 11 (14%), respectively, at baseline, and 9 (11%), 32 (40%), and 40 (49%) at 18-month post-surgery follow up. A significant reduction in steatosis, liver fibrosis, lobular inflammation, and hepatocyte ballooning was observed in the postoperative biopsies (P < 0.001 each). In addition, at the follow-up assessment, there was a significant increase in serum adiponectin levels and significant decline in serum levels of leptin, resisitin, and pre-B cell enhancing factor/Nampt/visfatin. CONCLUSION: Weight loss after sleeve gastrectomy was associated with a significant improvement in several metabolic parameters, liver enzyme levels, liver histopathology, and changes in serum adipokine levels towards antidiabetic and anti-inflammatory profiles.
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Salman et al. (2020) conducted a cohort in non-alcoholic fatty liver disease (n=81). Laparoscopic sleeve gastrectomy vs. Baseline was evaluated on Definite non-alcoholic steatohepatitis. Laparoscopic sleeve gastrectomy reduced the prevalence of definite non-alcoholic steatohepatitis from 53% at baseline to 11% at 18 months post-surgery.
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