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Bariatric Surgery Provides Long-term Resolution of Nonalcoholic Steatohepatitis and Regression of Fibrosis
Open accessAbstract
Background and Aims Studies are needed to determine the long-term effects of bariatric surgery for patients with nonalcoholic steatohepatitis (NASH). We evaluated sequential liver samples, collected the time of bariatric surgery and 1 and 5 years later, to assess the long-term effects of bariatric surgery in patients with NASH. Methods We performed a prospective study of 180 severely obese patients with biopsy-proven NASH, defined by the NASH clinical research network histologic scores. The patients underwent bariatric surgery at a single center in France and were followed for 5 years. We obtained liver samples from 125 of 169 patients (76%) having reached 1 year and 64 of 94 patients (68%) having reached 5 years after surgery. The primary endpoint was the resolution of NASH without worsening of fibrosis at 5 years. Secondary end points were improvement in fibrosis (reduction of ≥1 stage) at 5 years and regression of fibrosis and NASH at 1 and 5 years. Results At 5 years after bariatric surgery, NASH was resolved, without worsening fibrosis, in samples from 84% of patients (n = 64; 95% confidence interval, 73.1%-92.2%). Fibrosis decreased, compared with baseline, in samples from 70.2% of patients (95% CI, 56.6%-81.6%). Fibrosis disappeared from samples from 56% of all patients (95% CI, 42.4%-69.3%) and from samples from 45.5% of patients with baseline bridging fibrosis. Persistence of NASH was associated with no decrease in fibrosis and less weight loss (reduction in body mass index of 6.3 ± 4.1 kg/m 2 in patients with persistent NASH vs reduction of 13.4 ± 7.4 kg/m 2 ; P = .017 with resolution of NASH). Resolution of NASH was observed at 1 year after bariatric surgery in biopsies from 84% of patients, with no significant recurrence between 1 and 5 years ( P = .17). Fibrosis began to decrease by 1 year after surgery and continued to decrease until 5 years ( P < .001). Conclusions In a long-term follow-up of patients with NASH who underwent bariatric surgery, we observed resolution of NASH in liver samples from 84% of patients 5 years later. The reduction of fibrosis is progressive, beginning during the first year and continuing through 5 years.
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“In an observational study, MASH was resolved in 84% of 180 individuals with class 2 obesity and MASH 5 years after Roux-en-Y gastric bypass (66%), sleeve gastrectomy (12%) or gastric banding (22%).”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [443]
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“Pioglitazone therapy, GLP-1 RA therapy, and metabolic surgery have all been shown to reduce NASH activity; pioglitazone therapy and metabolic surgery may also improve hepatic fi brosis (188,292 -298).”
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“One of the most promising developments in the field is the growing consensus that liver fibrosis can be a reversible process under certain conditions, particularly if the underlying cause of injury is removed (84–86).”
From Targeting macrophages in liver fibrosis (2026) · cites this paper as [85]
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“Procedures like Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are associated with significant metabolic improvements and reductions in NAFLD severity [13,14,15], including reductions in liver fat, liver enzymes, and fibrosis [16,17,18].”
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 [16]
In the citing paper
“The reduction of fibrosis is progressive, beginning during the first year and continuing through 5 years [4,127].”
From Hepatic Insulin Resistance and Steatosis in Metabolic Dysfunction-Associated Steatotic Liver Disease: New Insights into Mechanisms and Clinical Implications (2025) · cites this paper as [127]
In the citing paper
“In a long-term follow-up study of patients with MASH who underwent bariatric surgery, the resolution of MASH in liver samples was observed from 84% of patients 5 years later.”
From Hepatic Insulin Resistance and Steatosis in Metabolic Dysfunction-Associated Steatotic Liver Disease: New Insights into Mechanisms and Clinical Implications (2025) · cites this paper as [127]
In the citing paper
“Weight loss either through lifestyle intervention68 or bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy)69,70 improves the lipid profile by reducing total TAGs, and increasing PC, PE and HDL concentrations.125”
From Lipid metabolism in MASLD and MASH: From mechanism to the clinic (2024) · cites this paper as [70]
In the citing paper
“Nevertheless, these interventions suggest that, like HCV and HBV, MASH fibrosis is reversible in non-cirrhotic liver, but unlike in HCV and HBV there is no evidence yet that cirrhosis in MASH is reversible (259).”
From Found in translation—Fibrosis in metabolic dysfunction–associated steatohepatitis (MASH) (2023) · cites this paper as [259]
In the citing paper
“Wound healing in the liver is dynamic and reversible,105 with ample evidence of fibrosis regression after effective treatment of viral hepatitis, and even following bariatric surgery in patients with NASH.106”
From An integrated view of anti-inflammatory and antifibrotic targets for the treatment of NASH (2023) · cites this paper as [106]
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“The risks of surgery procedures and side effects render bariatric surgery the last, but also almost the only, choice to treat morbid obesity and NASH.[4,5] When voluntary lifestyle and dietary strategies fail, alternative pharmacological therapeutics are urgently warranted.”
Background2023 Clinical Practice Guidelines for Diabetes Mellitus of the Korean Diabetes Association
Choi, J. H., Lee, K. A., Moon, J. H., Chon, S., Kim, D. J., Kim, H. J., Kim, N. H., Seo, J. A., Kim, M. K., Lim, J. H., et al. (2023) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2023.0282 · Cited by 130
Therapeutic targeting of hepatic ACSL4 ameliorates NASH in mice
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“[2] Currently, lifestyle modification and bariatric surgery are the two most effective and evidence- based therapeutic options for early NASH.”
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“According to a prospective 5-year follow-up of obesity patients with NASH by Lassailly et al, the positive effects of bariatric surgery on the resolution of NASH were long-lasting and resulted in a sustained decrease in fibrosis (28).”
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“4 kg/m(2)) was associated with long-term NASH resolution, with 84% of patients having NASH resolution without worsening in fibrosis starting at 1 year after surgery and persisting at 5 years [107].”
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Relationship of Nonalcoholic Fatty Liver Disease and Heart Failure With Preserved Ejection Fraction
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“In a prospective study with biopsy-proven NASH, bariatric surgery resulted in resolution of NASH in 84% of patients at 1 year following surgery (120).”
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Inflammatory and fibrotic mechanisms in NAFLD—Implications for new treatment strategies
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Persistence of severe liver fibrosis despite substantial weight loss with bariatric surgery
Pais, R., Aron‐Wisnewsky, J., Bedossa, P., Ponnaiah, M., Oppert, J., Siksik, J., Genser, L., Charlotte, F., Thabut, D., Clement, K., et al. (2022) · Hepatology · doi:10.1002/hep.32358 · Cited by 95
“This was suggested by Lassailly et al., albeit in a population with milder disease at baseline.”
BackgroundResultInfluentialTreatment of liver fibrosis: Past, current, and future
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The Link between NAFLD and Metabolic Syndrome
Radu, F., Potcovaru, C.-G., Salmen, T., Filip, P. V., Pop, C. S., & Fierbinteanu-Braticevici, C. G. (2023) · Diagnostics · doi:10.3390/diagnostics13040614 · Cited by 104
“[34] reported long-term outcomes in a group of 180 patients with severe obesity and biopsy-confirmed NASH who underwent metabolic and bariatric surgery (MBS).”
Diabetes and cirrhosis: Current concepts on diagnosis and management
Castéra, L., & Cusi, K. J. (2023) · Hepatology · doi:10.1097/hep.0000000000000263 · Cited by 87
“1 year[136] and 5 years of follow-up.[137] Survival benefit with bariatric surgery has been demonstrated in general patient populations, although data for improved transplant-free survival in cirrhosis are lacking.”
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“222 In a retrospective study, surgery was associated with a reduction of the 10-year adjusted risk of incident major adverse liver and cardiovascular outcomes of 12.4% and 13.9%, respectively.”
InfluentialSelf-citationNASH drug treatment development: challenges and lessons
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“The reduction of fibrosis is progressive, beginning during the first year and continuing through 5 years [4,127].”
Bariatric surgery improves nonalcoholic fatty liver disease: systematic review and meta-analysis
Zhou, H., Luo, P., Li, P., wang, G., Yi, X., Fu, Z., Sun, X., Cui, B., Zhu, L., & Zhu, S. (2022) · Obesity Surgery · doi:10.1007/s11695-022-06011-1 · Cited by 79
Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease
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“, 2015 [178,179] 180 morbidly obese patients with biopsy-proven NASH Bariatric surgery (gastric banding; gastric bypass; Rouxen-Y-Gastric-bypass; sleeve gastrectomy) Prospective study 3 Bariatric surgery induced the disappearance of NASH from nearly 85% of patients and reduced the pathologic features of the disease af…”
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Mejía-Guzmán, J. E., Belmont-Hernández, R. A., Chávez-Tapia, N. C., Uribe, M., & Nuño‐Lámbarri, N. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26072959 · Cited by 82
“[ 132].”
Antifibrotic therapy in nonalcoholic steatohepatitis: time for a human-centric approach
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Metabolic mechanisms for and treatment of NAFLD or NASH occurring after liver transplantation
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Prevention of cardiorenal complications in people with type 2 diabetes and obesity
Drucker, D. J. (2024) · Cell Metabolism · doi:10.1016/j.cmet.2023.12.018 · Cited by 68
Bariatric Surgery and Osteoporosis
Paccou, J., Caiazzo, R. J., Lespessailles, É., & Cortet, B. (2021) · Calcified Tissue International · doi:10.1007/s00223-020-00798-w · Cited by 68
Self-citationIs there an ‘ideal’ diet for patients with NAFLD?
Pugliese, N., Torres, M. C. P., Petta, S., Valenti, L. V. C., Giannini, E. G., & Aghemo, A. (2021) · European Journal of Clinical Investigation · doi:10.1111/eci.13659 · Cited by 73
Bosch, J., Chung, C., Carrasco‐Zevallos, O. M., Harrison, S. A., Abdelmalek, M. F., Shiffman, M. L., Rockey, D. C., Shanis, Z., Juyal, D., Pokkalla, H., et al. (2021) · Hepatology · doi:10.1002/hep.32087 · Cited by 65
“9 53 (43, 63) 52 (38, 66) 68 (57, 78) 36 (25, 48)”
MethodInfluentialObesity Modifies the Performance of Fibrosis Biomarkers in Nonalcoholic Fatty Liver Disease
Qadri, S. U., Ahlholm, N., Lønsmann, I., Pellegrini, P., Poikola, A., Luukkonen, P. K., Porthan, K., Juuti, A., Sammalkorpi, H. E., Penttilä, A. K., et al. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab933 · Cited by 63
Steatotic Liver Disease: Metabolic Dysfunction, Alcohol, or Both?
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“A French study with serial liver biopsies at the time of surgery, 1 year later, and 5 years later has demonstrated resolution of NASH without worsening of fibrosis at 5 years in 84% and improvement of fibrosis by ≥1 stage at 5 years in 70% of patients [103,104].”
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Self-citationTargeting Sirtuin1 to treat aging-related tissue fibrosis: From prevention to therapy
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“Morbidly obese patients undergoing bariatric surgery (sleeve gastrectomy and gastric bypass) were achieving MASH resolution in 85 % of cases after 1 year, and displayed progressive trends in fibrosis regression after 5 years [4].”
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Nonalcoholic Steatohepatitis and HCC in a Hyperphagic Mouse Accelerated by Western Diet
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Updates on novel pharmacotherapeutics for the treatment of nonalcoholic steatohepatitis
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“Bariatric surgery often leads to durable weight reduction, at the same time liver fat content is reduced, and hepatic fibrosis is improved [5]; nevertheless this procedure is not suggested for NASH patients as a practical guideline due to the surgical risk.”
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“2% and was completely resolved in 56%.(75) Regarding the procedure, it seems that both”
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Metadata
- Authors
- Lassailly, G., Caiazzo, R., Ntandja-Wandji, L.-C., Gnemmi, V., Baud, G., Verkindt, H., Ningarhari, M., Louvet, A., Leteurtre, E., Raverdy, V., Dharancy, S., Pattou, F., & Mathurin, P.
- Affiliations
- Inserm (FR)
- Centre National de la Recherche Scientifique (FR)
- Corresponding author
- Pattou, François
- Mathurin, Philippe
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 159
- Issue
- 4
- Pages
- 1290-1301.e5
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W3034346518
- Cited by
- 622
- References
- 27
- Citations by year
- 2026: 93 · 2025: 105 · 2024: 109 · 2023: 106 · 2022: 108 · 2021: 89 · 2020: 11
- FWCI
- 56.22
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Gastroenterology (acceptedVersion, other-oa)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by-nc)
- HAL (submittedVersion)
- LillOA (Université de Lille (University Of Lille)) (submittedVersion, other-oa)
- Funders
- European Regional Development Fund
- Agence Nationale de la Recherche (ANR-10-LABX-46, ANR-16-RHUS-0006)
- Ministère des Affaires Sociales et de la Santé
- European Commission
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- bariatric surgery, nonalcoholic steatohepatitis, liver fibrosis regression, obesity, long-term outcomes, weight loss, NASH resolution, liver biopsy histology, bridging fibrosis, metabolic surgery, liver cancer risk, liver transplantation risk
- MeSH terms
- Adult, Biopsy, Female, Follow-Up Studies, France, Humans, Liver, Liver Cirrhosis, Male, Middle Aged, Obesity, Morbid, Prospective Studies, Remission Induction, Time Factors, Weight Loss, Treatment Outcome, Bariatric Surgery, Non-alcoholic Fatty Liver Disease
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