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

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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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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 › Hepatology › 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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