Cited by 622Liver Disease Diagnosis and TreatmentBariatric Surgery and OutcomesOrgan Transplantation Techniques and Outcomes

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Bariatric Surgery Provides Long-term Resolution of Nonalcoholic Steatohepatitis and Regression of Fibrosis

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Abstract

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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Crossref · 10.1053/j.gastro.2020.06.006

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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
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
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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