medwireNews: Gastric bypass and sleeve gastrectomy both result in “almost complete clearance of liver fat” within a year after the intervention, show secondary outcomes of a randomized trial.
This was despite the trial’s previously reported primary findings demonstrating significantly greater remission of type 2 diabetes with gastric bypass than with gastrectomy.
Among the 100 study participants who underwent liver magnetic resonance imaging at baseline, the average liver fat fraction was 19.2% in the 50 randomly assigned to undergo Roux-en-Y gastric bypass and 19.0% in the 50 assigned to sleeve gastrectomy.
This fell rapidly within weeks of surgery to a corresponding 6.3% and 6.0% at 5 weeks, and reduced to near zero by 1 year. All except three participants, who were all in the sleeve gastrectomy group, had a liver fat fraction of 10% or less by this point, compared with around a quarter of the participants at baseline.
“Patients with hepatic steatosis and advanced liver fibrosis are at high risk for progressing to end-stage liver disease,” write Jens Kristoffer Hertel (Vestfold Hospital Trust, Tønsberg, Norway) and co-researchers in the Annals of Internal Medicine.
But despite the clear improvements in liver fat, “the liver fibrosis findings were less conclusive,” they say.
Liver fibrosis was assessed according to the enhanced liver fibrosis (ELF) score, a biomarker-based score that the researchers say is “a proven and noninvasive marker for evaluating liver fibrosis,” which “correlates well with the level of liver fibrosis assessed by liver biopsy.”
The average ELF score increased from 8.4 to 8.9 between baseline and 1 year in the gastric bypass group and from 8.5 to 8.7 in the sleeve gastrectomy group.
“We were concerned that the majority of patients (69%) had an increase in their ELF score, and 1 of 5 patients progressed to a higher grade of fibrosis (ELF category) during the study,” remark the study authors.
The proportion of participants with an ELF score of 9.8 or higher, indicating severe fibrosis, rose from 6% to 15% in the gastric bypass group and from 8% to 9% in the gastrectomy group.
Fibrosis determined according to the non-alcoholic fatty liver disease fibrosis score regressed in both treatment groups, but the researchers point out that this score “is strongly influenced by the drop in BMI and improvement in glycemia after bariatric surgery and might therefore be less well suited [than the ELF score] for assessment of fibrosis progression or regression after bariatric surgery.”
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