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Effects of Laparoscopic Sleeve Gastrectomy on Non-Alcoholic Steatohepatitis and Liver Fibrosis in Japanese Patients with Severe Obesity

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Abstract

Background

The prevalence of non-alcoholic steatohepatitis (NASH) in Japanese patients with severe obesity is extremely high. The aim of the present study was to evaluate the metabolic and histological effects of laparoscopic sleeve gastrectomy (LSG) on NASH and liver fibrosis in Japanese patients with severe obesity.

Methods

Between June 2008 and March 2019, all 79 patients with severe obesity who underwent LSG were included in the study. Sixty-eight patients had an intraoperative liver biopsy performed at the time of LSG. Ultrasound-guided liver biopsies were performed in patients with fibrosis at 12 months after LSG.

Results

NASH was present in 43 patients (63.2%), and 10 patients had a unique feature in which their fibrosis were observed without steatosis at the time of LSG. Of the 28 patients with NASH, 25 showed improvement and no longer met the diagnostic criteria of NASH at 12 months after LSG. Mean pericellular fibrosis scores showed significant improvement from 1.62 at baseline, to 1.50, 1.00, and 0.78, respectively (p < 0.001). Univariate analysis of the preoperative predictors in the improvement of fibrosis showed significant effects in preoperative weight (p = 0.037), HbA1c (p = 0.037), and serum insulin (p = 0.037). Multivariate analysis revealed HbA1c to be the only preoperative predictor of improvement in fibrosis (p = 0.004; odds ratio 0.440, 95% CI 0.229–0.842).

Conclusions

LSG has great potential as an effective treatment for patients with NASH.

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References

  1. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288(14):1723–7.

    Article  Google Scholar 

  2. Flegal KM, Kruszon-Morgan D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–91.

    Article  CAS  Google Scholar 

  3. Seki Y, Kakizaki S, Horiguchi N, et al. Prevalence of nonalcoholic steatohepatitis in Japanese patients with morbid obesity undergoing bariatric surgery. J Gastroenterol. 2016;51:281–9.

    Article  Google Scholar 

  4. Bower G, Toma T, Harling L, et al. Bariatric surgery and non-alcoholic fatty liver disease: a systematic review of liver biochemistry and histology. Obes Surg. 2015;25:2280–9.

    Article  Google Scholar 

  5. Lassailly G, Caiazzo R, Buob D, et al. Bariatric surgery reduces features of nonalcoholic steatohepatitis in morbidly obese patients. Gastroenterol. 2015;149:379–88.

    Article  Google Scholar 

  6. Haruta H, Kasama K, Ohta M, et al. Long-term outcomes of bariatric surgery in Japan: results of a multi-institutional survey. Obes Surg. 2017;27:754–62.

    Article  Google Scholar 

  7. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  Google Scholar 

  8. Sasaki A, Nitta H, Otsuka K, et al. Bariatric surgery and non-alcoholic fatty liver disease: current and potential future treatments. Front Endocrinol(Lausanne). 2014;5:164.

    Google Scholar 

  9. Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.

    Article  Google Scholar 

  10. Sumida Y, Yoneda M, Hyogo H, et al. A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease. J Gastroenterol. 2011;46:257–68.

    Article  CAS  Google Scholar 

  11. Shah AG, Lydecker A, Murray K, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatrol. 2009;7:1004–112.

    Google Scholar 

  12. Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–54.

    Article  CAS  Google Scholar 

  13. Brunt EM, Janney CG, Di Bisceglie AM, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94:2467–74.

    Article  CAS  Google Scholar 

  14. Sakamoto M, Tsujikawa H, Effendi K, et al. Pathological findings of nonalcoholic steatohepatitis and nonalcoholic fatty liver disease. Pathol Int. 2017;67:1–7.

    Article  Google Scholar 

  15. National Health and Nutrition Survey. https://www.mhlw.go.jp/bunya/kenkou/kenkou_eiyou_chousa.html. Accessed 11 Nov 2019.

  16. Ratziu V, Giral P, Charlotte F, et al. Liver fibrosis in overweight patients. Gastroenterology. 2000;118:1117–23.

    Article  CAS  Google Scholar 

  17. Eguchi Y, Hyogo H, Ono M, et al. Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study. J Gastroenterol. 2012;47:586–95.

    Article  CAS  Google Scholar 

  18. Sumida Y, Yoneda M, Hyogo H, et al. Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population. BMC Gastroenterol. 2012;12:2.

  19. Wong VW, Wong GL, Chim AM, et al. Validation of the NAFLD fibrosis score in a Chinese population with low prevalence of advanced fibrosis. Am J Gastroenterol. 2008;103:1682–8.

    Article  Google Scholar 

  20. Matteoni CA, Younossi ZM, Gramich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116:1413–9.

    Article  CAS  Google Scholar 

  21. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    Article  Google Scholar 

  22. Cummings DE, Cohen RV. Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery. Lancet Diabetes Endocrinol. 2014;2:175–81.

    Article  Google Scholar 

  23. Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24:437–55.

    Article  CAS  Google Scholar 

  24. Migrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomized controlled trial. Lancet. 2015;386:964–73.

    Article  Google Scholar 

  25. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–23.

    Article  Google Scholar 

  26. Cherla DV, Rodriguez NA, Vangoitsenhoven R, et al. Impact of sleeve gastrectomy and Roux-en-Y gastric bypass on biopsy-proven non-alcoholic fatty liver disease. Surg Endosc. 2019. https://doi.org/10.1007/s00464-019-07017-0.

  27. Sasaki A, Wakabayashi G, Yonei Y, et al. Current status of bariatric surgery in Japan and effectiveness in obesity and diabetes. J Gastroenterol. 2014;49:57–63.

    Article  CAS  Google Scholar 

  28. Uehara D, Seki Y, Kakizaki S, et al. Long-term results of bariatric surgery for non-alcoholic fatty liver disease/non-alcoholic steatohepatitis treatment in morbidly obese Japanese patients. Obes Surg. 2019;29:1195–201.

    Article  Google Scholar 

  29. Endo Y, Ohta M, Tada K, et al. Improvement od non-alcoholic fatty liver disease after laparoscopic sleeve gastrectomy in Japanese obese patients. Ann Gastroenterol Surg. 2019;3:285–90.

    Article  Google Scholar 

  30. von Schönfels W, Beckmann JH, Ahrens M, et al. Histologic improvement of NAFLD in patients with obesity after bariatric surgery based on standardized NAS (NAFLD activity score). Surg Obes Relat Dis. 2018;14:1607–17.

    Article  Google Scholar 

  31. Dulai PS, Singh S, Patel J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65:1557–65.

    Article  CAS  Google Scholar 

  32. Loomba R. The hierarchical model of NAFLD: prognostic significance of histologic features in NASH. Gastroenterology. 2015;149:278–80.

    Article  Google Scholar 

  33. Nakahara T, Hyogo H, Yoeda M, et al. Japan Study Group of Nonalcoholic Fatty Liver Disease. Type 2 diabetes mellitus associated with the fibrosis severity in patients with nonalcoholic fatty liver disease in a large retrospective cohort of Japanese patients. J Gastroenterol. 2014;49(11):1477–84.

    Article  CAS  Google Scholar 

  34. Shima T, Seki K, Umemura A, et al. Influence of lifestyle-related diseases and age on the development and progression of non-alcoholic fatty liver disease. Hepatol Res. 2015;45(5):548–59.

    Article  Google Scholar 

  35. Baldwin D, Chennakesavalu M, Gangemi A, et al. Systematic review and meta-analysis of Roux-en-Y gastric bypass against laparoscopic sleeve gastrectomy for amelioration of NAFLD using four criteria. Surg Obes Relat Dis. 2019;15:2123–30.

    Article  Google Scholar 

  36. Caiazzo R, Lassailly G, Leteurtre E, et al. Roux-en-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease. Ann Surg. 2014 Nov;260(5):893–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Shiwa, 028-3695, Japan

    Haruka Nikai, Akira Umemura, Shigeaki Baba, Hiroyuki Nitta & Akira Sasaki

  2. Department of Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Shiwa, 028-3695, Japan

    Kazuyuki Ishida & Tamotsu Sugai

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  1. Haruka Nikai
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  2. Kazuyuki Ishida
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  3. Akira Umemura
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Correspondence to Akira Sasaki.

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All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional and/or Japanese national research committees and with the 1964 Helsinki Declaration and later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in this study.

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Nikai, H., Ishida, K., Umemura, A. et al. Effects of Laparoscopic Sleeve Gastrectomy on Non-Alcoholic Steatohepatitis and Liver Fibrosis in Japanese Patients with Severe Obesity. OBES SURG 30, 2579–2587 (2020). https://doi.org/10.1007/s11695-020-04515-2

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  • DOI: https://doi.org/10.1007/s11695-020-04515-2

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