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. 2023 Oct 1;12(5):658-670.
doi: 10.21037/hbsn-21-520. Epub 2022 Jun 20.

Foregut bypass vs. restrictive bariatric procedures for nonalcoholic fatty liver disease: a meta-analysis of 3,355 individuals

Wen Hui Lim #  1 , Snow Yunni Lin #  1 , Cheng Han Ng  1 , Darren Jun Hao Tan  1 , Jieling Xiao  1 , Jie Ning Yong  1 , Phoebe Wen Lin Tay  1 , Nicholas Syn  1 , Yip Han Chin  1 , Kai En Chan  1 , Chin Meng Khoo  1   2 , Nicholas Chew  1   3 , Roger S Y Foo  1   3 , Asim Shabbir  4 , Eunice X Tan  1   5   6 , Daniel Q Huang  1   5   6 , Mazen Noureddin  7 , Arun J Sanyal  8 , Mohammad Shadab Siddiqui #  8 , Mark D Muthiah #  1   5   6
Affiliations

Foregut bypass vs. restrictive bariatric procedures for nonalcoholic fatty liver disease: a meta-analysis of 3,355 individuals

Wen Hui Lim et al. Hepatobiliary Surg Nutr. .

Abstract

Background: Bariatric surgery represents an important treatment option for severely obese patients with nonalcoholic fatty liver disease (NAFLD). However, there remains inadequate data regarding the effects of different bariatric procedures on various NAFLD parameters, especially for histological outcomes. Thus, this meta-analysis aimed to compare the effects of restrictive bariatric procedures and foregut bypass on the metabolic, biochemical, and histological parameters for patients with NAFLD.

Methods: Medline and Embase were searched for articles relating to bariatric procedures and NAFLD. Pairwise meta-analysis was conducted to compare efficacy of bariatric procedures pre- vs. post-procedure with subgroup analysis to further compare restrictive against foregut bypass procedures.

Results: Thirty-one articles involving 3,355 patients who underwent restrictive bariatric procedures (n=1,460) and foregut bypass (n=1,895) were included. Both foregut bypass (P<0.01) and restrictive procedures (P=0.03) significantly increased odds of fibrosis resolution. Compared to restrictive procedures, foregut bypass resulted in a borderline non-significant decrease in fibrosis score (P=0.06) and significantly lower steatosis score (P<0.001). For metabolic parameters, foregut bypass significantly lowered body mass index (P=0.003) and low-density lipoprotein (P=0.008) compared to restrictive procedures. No significant differences were observed between both procedures for aspartate aminotransferase (P=0.17) and alkaline phosphatase (P=0.61). However, foregut bypass resulted in significantly lower gamma-glutamyl transferase than restrictive procedures (P=0.01) while restrictive procedures resulted in significantly lower alanine transaminase than foregut bypass (P=0.02).

Conclusions: The significant histological and metabolic advantages and comparable improvements in biochemical outcomes support the choice of foregut bypass over restrictive bariatric procedures in NAFLD management.

Keywords: Bariatric surgery; endoscopy; fibrosis; non-alcoholic fatty liver disease (NAFLD); obesity.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-21-520/coif). AJS is President of Sanyal Biotechnology and has stock options in Genfit, Akarna, Tiziana, Indalo, Durect and Galmed. He has served as a consultant to Astra Zeneca, Nitto Denko, Enyo, Ardelyx, Conatus, Nimbus, Amarin, Salix, Tobira, Takeda, Jannsen, Gilead, Terns, Birdrock, Merck, Valeant, Boehringer-Ingelheim, Lilly, Hemoshear, Zafgen, Novartis, Novo Nordisk, Pfizer, Exhalenz and Genfit. He has been an unpaid consultant to Intercept, Echosens, Immuron, Galectin, Fractyl, Syntlogic, Affimune, Chemomab, Zydus, Nordic Bioscience, Albireo, Prosciento, Surrozen and Bristol Myers Squibb. His institution has received grant support from Gilead, Salix, Tobira, Bristol Myers, Shire, Intercept, Merck, Astra Zeneca, Malinckrodt, Cumberland and Norvatis. He receives royalties from Elsevier and UptoDate. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Mechanism of restrictive bariatric procedures versus foregut bypass. GIP, gastric inhibitory peptide; PYY, peptide YY; GLP-1, glucagon-like peptide-1.
Figure 2
Figure 2
PRISMA flow diagram.
Figure 3
Figure 3
Fibrosis grade (F0/F1) after sleeve gastrectomy versus Roux-en-Y gastric bypass.
Figure 4
Figure 4
Summary of overall outcomes between restrictive bariatric procedures and foregut bypass.
See this image and copyright information in PMC

Comment in

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