Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 24;10(17):3783.
doi: 10.3390/jcm10173783.

Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Non-Alcoholic Fatty Liver Disease: A 12-Month Follow-Up Study with Paired Liver Biopsies

Julie Steen Pedersen  1 , Marte Opseth Rygg  1 , Reza Rafiolsadat Serizawa  2 , Viggo Bjerregaard Kristiansen  3 , Nicolai J Wewer Albrechtsen  4   5   6 , Lise Lotte Gluud  1 , Sten Madsbad  7 , Flemming Bendtsen  1
Affiliations

Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Non-Alcoholic Fatty Liver Disease: A 12-Month Follow-Up Study with Paired Liver Biopsies

Julie Steen Pedersen et al. J Clin Med. .

Abstract

Roux-en-Y gastric bypass (RYGB) improves, and can sometimes resolve, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) but data based on histological assessment for the efficacy of sleeve gastrectomy (SG) in resolving NAFLD are sparse. Consequently, we aimed to compare the efficacy of RYGB vs. SG on NAFLD 12 months after surgery. In a prospective cohort study, 40 patients with obesity underwent bariatric surgery (16 RYGB and 24 SG). During surgery, a liver biopsy was taken and repeated 12 months later. NAFLD severity was evaluated using the NAFLD Activity Score (NAS) and Kleiner Fibrosis score. RYGB and SG patients were comparable at baseline. Mean (standard deviation, SD) NAS was 3.3 (0.9) in RYGB and 3.1 (1.4) in SG (p = 0.560) with similar degrees of steatosis, inflammation, and ballooning. Two RYGB patients, and six SG patients, had NASH (p = 0.439). Twelve months after surgery, NAS was significantly and comparably (p = 0.241) reduced in both RYGB (-3.00 (95% CI -3.79--2.21), p < 0.001) and SG (-2.25 (95% CI -2.92--1.59), p < 0.001) patients. RYGB patients had significantly more reduced (p = 0.007) liver steatosis (-0.91 (95% CI -1.47--1.2) than SG patients (-0.33 (95% CI -0.54--0.13) and greater improvement in the plasma lipid profile. Fibrosis declined non-significantly. NASH was resolved in seven of eight patients without a worsening of their fibrosis. RYGB and SG have similar beneficial effects on NAS and NASH without the worsening of fibrosis. RYGB is associated with a more pronounced reduction in liver steatosis.

Keywords: Roux-en-Y gastric bypass; bariatric surgery; liver histology; non-alcoholic fatty liver disease; non-alcoholic fatty liver disease activity score; sleeve gastrectomy.

PubMed Disclaimer

Conflict of interest statement

Julie Steen Pedersen, Marte Opseth Rygg, Nicolai J. Wever Albrechtsen and Flemming Bendtsen have received grants from Novo Nordisk. Sten Madsbad consults for and receives grants from Novo Nordisk. Lise Lotte Gluud consults for and receives grants from Novo Nordisk, Gilead and Alexion.

Figures

Figure 1
Figure 1
Flowchart of study subjects between baseline liver biopsy and 12 month follow-up liver biopsy.
Figure 2
Figure 2
Liver histology in RYGB and SG at baseline and 12 months after surgery. NAFLD activity score (NAS) and the sub-scores for steatosis, inflammation, and ballooning, in addition to the fibrosis score in (A) Roux-en-Y gastric bypass (RYGB) vs. sleeve gastrectomy (SG) at baseline (day of surgery), (B) RYGB vs. SG 12 months after surgery, (C) in RYGB patients at baseline and 12 months after surgery, (D) in SG patients at baseline and 12 months after surgery, and (E) the delta changes (12 months after surgery—baseline) in RYGB vs. SG. Data are mean (SD), n = 40 (RYGB: n = 16, SG: n = 24).
See this image and copyright information in PMC

References

    1. O’Brien P.E., Hindle A., Brennan L., Skinner S., Burton P., Smith A., Crosthwaite G., Brown W. Long-Term Outcomes After Bariatric Surgery: A Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding. Obes. Surg. 2018;29:3–14. doi: 10.1007/s11695-018-3525-0. - DOI - PMC - PubMed
    1. Salminen P., Helmiö M., Ovaska J., Juuti A., Leivonen M., Peromaa-Haavisto P., Hurme S., Soinio M., Nuutila P., Victorzon M. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years among Patients with Morbid Obesity. JAMA. 2018;319:241–254. doi: 10.1001/jama.2017.20313. - DOI - PMC - PubMed
    1. Borgeraas H., Hofsø D., Hertel J.K., Hjelmesaeth J. Comparison of the effect of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Obes. Rev. 2020;21:e13011. doi: 10.1111/obr.13011. - DOI - PMC - PubMed
    1. Hofsø D., Fatima F., Borgeraas H., Birkeland K.I., Gulseth H.L., Hertel J.K., Johnson L.K., Lindberg M., Nordstrand N., Småstuen M.C., et al. Gastric bypass versus sleeve gastrectomy in patients with type 2 diabetes (Oseberg): A single-centre, triple-blind, randomised controlled trial. Lancet Diabetes Endocrinol. 2019;7:912–924. doi: 10.1016/S2213-8587(19)30344-4. - DOI - PubMed
    1. Osland E., Yunus R.M., Khan S., Memon B., Memon M.A. Diabetes improvement and resolution following laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures: A systematic review of randomized controlled trials. Surg. Endosc. 2016;31:1952–1963. doi: 10.1007/s00464-016-5202-5. - DOI - PubMed