Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis

Kral, John G; Thung, Swan N; Biron, Simon; Hould, Frederic-Simon; Lebel, Stefane; Marceau, Simon; Simard, Serge; Marceau, Picard

doi:10.1016/j.surg.2003.10.003

Cited by 322Bariatric Surgery and OutcomesLiver Disease Diagnosis and TreatmentLiver Disease and Transplantation

Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis

Kral, John G, Thung, Swan N, Biron, Simon, Hould, Frederic-Simon, Lebel, Stefane, Marceau, Simon, Simard, Serge, Marceau, Picard·2004·Surgery

DOI 10.1016/j.surg.2003.10.003

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Abstract

Background Both weight loss and gastrointestinal surgery for obesity can cause liver disease, making their role in the treatment of obesity-related liver disease controversial. Methods Six hundred eighty-nine severely obese women (n=551) and men (n=138), BMI=47+/-9 kg.m(-2) (mean+/-SD), without known liver disease, underwent biliopancreatic diversion (BPD) with liver biopsy. Fourteen patients (2%) had cryptogenic cirrhosis, 11 of whom underwent multiple repeat biopsies. After 38+/-18 kg weight loss, 104 of the 689 patients underwent routine second biopsies during reoperations 41+/-25 months after BPD. All biopsy specimens were graded for steatosis, fibrosis, and inflammation by a blinded hepatopathologist. Results All 689 patients lost weight accompanied by improvements in the metabolic syndrome. Among the 104 patients who underwent reoperation, severe fibrosis (grade 3-5) decreased in 28 whereas mild fibrosis (grade 1-2) appeared in 42. Increased fibrosis was related to low-normal serum albumin, uncontrolled diarrhea, low intake of alcohol, and menopausal status. Fibrosis and inflammation decreased over time (P<.01). The 11 patients with cirrhosis exhibited decreased fibrosis from a mean grade 5 to grade 3, as well as reduced inflammation, Mallory bodies, and glycogenated nuclei. Seven patients had disappearance and 2 regression of nodules and fibrous bridging. Conclusions The metabolic syndrome of obesity is a determinant of liver fibrosis and cirrhosis, treatable by substantial weight loss after malabsorptive surgery.

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One series found fibrosis scores worsened in 40% of patients (improved in 27%) after BPD-DS despite reduced steatosis.
“However, one series found fibrosis scores worsened in 40% of patients (improved in 27%) despite reduced steatosis [53].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [53]
The complexity, risks of malabsorption and nutritional consequences, and rare potential for accelerated liver fibrosis limit widespread adoption of BPD-DS.
“However, its complexity, risks of malabsorption and its nutritional consequences, and the rare potential for accelerated liver fibrosis limit widespread adoption [53,58,59,60].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [53]
BPD-DS leads to resolution of steatohepatitis in a majority of patients and can regress advanced disease.
“Accordingly, BPD-DS leads to resolution of steatohepatitis in a majority of patients and can even regress advanced disease [53,54,55].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [53]

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Morbid obesity, nonalcoholic fatty liver disease, and weight loss surgery†
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Authors: Kral, J. G., Thung, S. N., Biron, S., Hould, F.-S., Lebel, S., Marceau, S., Simard, S., & Marceau, P.
Affiliations: State University of New York (US)
Corresponding author: Kral, John G
ORCID: Kral, John G
Thung, Swan N
Marceau, Simon
Venue: Surgery
Publisher: Elsevier BV
Published: 2004-01
Volume: 135
Issue: 1
Pages: 48-58
ISSN: 0039-6060 (ISSN-L)
DOI: 10.1016/j.surg.2003.10.003
OpenAlex: W2075060360
Cited by: 322
References: 69
Citations by year: 2026: 2 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 10 · 2021: 11 · 2020: 11 · 2019: 10 · 2018: 7 · 2017: 13 · 2016: 11 · 2015: 21 · 2014: 23 · 2013: 9 · 2012: 14
FWCI: 17.62
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Surgery (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Keywords: metabolic syndrome, obesity, liver fibrosis, liver cirrhosis, biliopancreatic diversion, bariatric surgery, weight loss, malabsorptive surgery, obesity-related liver disease, liver biopsy, steatosis, liver inflammation, serum albumin, menopause, fibrosis regression
MeSH terms: Adult, Biopsy, Fatty Liver, Female, Hepatitis, Humans, Liver, Liver Cirrhosis, Male, Middle Aged, Obesity, Morbid, Reoperation, Weight Loss, Biliopancreatic Diversion, Case-Control Studies, Single-Blind Method, Treatment Outcome, Metabolic Syndrome

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Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis

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