AGA Clinical Practice Update on Bariatric Surgery in Cirrhosis: Expert Review
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Bariatric surgery is the best studied technique for achieving weight loss in liver transplant candidates.
“Bariatric surgery is the best studied technique for achieving weight loss in liver transplant candidates but should only be considered after the failure of conservative measures. 500”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [500]
The section on optimal timing and method of bariatric surgery reports durable weight loss after combined liver transplantation and sleeve gastrectomy, supporting its use in transplant patients. Neither that section nor the discussion of non-invasive weight management establishes that bariatric surgery is the best-studied weight-loss method for transplant candidates. The paper discusses lifestyle measures but does not say surgery should be considered only after they fail; page numbers were not available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThe patient with obesity and compensated cirrhosis is at higher risk for perioperative mortality following MBS, but the risk remains small (<1%) and the benefits significant.
“The patient with obesity and compensated cirrhosis is at higher risk for perioperative mortality following MBS, but the risk remains small (<1%) and the benefits significant [94, 96, 97].”
Obesity conveys a 3-fold increase in the risk of liver decompensation in patients with known cirrhosis.
“At the same time, obesity conveys a 3-fold increase in the risk of liver decompensation in patients with known cirrhosis [94].”
Gastric or oesophageal varices and clinically significant portal hypertension are an absolute contraindication to endoscopic bariatric techniques such as intragastric balloons.
“Gastric or oesophageal varices and clinically signi fi cant portal hypertension are an absolute contraindication 499,500 although successful placement of these balloons (16.5% weight loss and 11% portal pressure reduction) after variceal eradication by band ligation has been reported in individuals with preserved liver function. 501”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [500]
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High MELD 3.0 score is not an absolute contraindication to bariatric surgery
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- Authors
- Patton, H., Heimbach, J., & McCullough, A.
- Affiliations
- VA San Diego Healthcare System (US)
- Mayo Clinic (US)
- Cleveland Clinic (US)
- Corresponding author
- Patton, Heather
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 19
- Issue
- 3
- Pages
- 436-445
- ISSN
- 1542-3565 (ISSN-L)
- PMC
- PMC8872426
- OpenAlex
- W3094582321
- Cited by
- 97
- References
- 87
- Citations by year
- 2026: 21 · 2025: 19 · 2024: 28 · 2023: 12 · 2022: 14 · 2021: 3
- FWCI
- 6.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (P50 AA024333, R01 HS02693, U01 AA021893)
- National Institute of Diabetes and Digestive and Kidney Diseases (UDK 505)
- California Public Utilities Commission
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- bariatric surgery, liver cirrhosis, obesity, non-alcoholic fatty liver disease, metabolic-associated fatty liver disease, morbid obesity, chronic liver disease, obesity prevalence
- MeSH terms
- Humans, Liver Cirrhosis, Bariatric Surgery
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