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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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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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In the citing paper
“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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In the citing paper
“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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“%] with fibrosis ≥F3 at baseline) to provide a robust conclusion in patients with advanced fibrosis, while limited evidence exists for the disappearance of fibrosis at 5 years, accounting for 45% of patients with baseline advanced fibrosis (≥F3) [12] .”
Jang, M. K., Yoon, S., An, J., Kim, J. S., Kim, M., Lee, J. A., Ko, C. S., & Min, S. H. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14207284 · Cited by 1
“Key factors associated with hepatic improvement include baseline glycemic status, hepatic histology, improvements in insulin resistance, and early postoperative weight loss [16,17].”
Position Statement on Cardiometabolic Health Across the Woman's Life Course – 2025
de Oliveira, G. M. M., de Almeida, M. C. C., Valério, C. M., Giuffrida, F. M. A., Espíndola, L. N., Izar, M. C. D. O., Marques-Santos, C., Freire, C. M. V., Albuquerque, C. J. D. M., Chagas, A. C. P., et al. (2025) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20250615i · Cited by 1
Posicionamento sobre a Saúde Cardiometabólica ao Longo do Ciclo de Vida da Mulher – 2025
de Oliveira, G. M. M., de Almeida, M. C. C., Valério, C. M., Giuffrida, F. M. A., Espíndola, L. N., Izar, M. C. D. O., Marques-Santos, C., Freire, C. M. V., Albuquerque, C. J. D. M., Chagas, A. C. P., et al. (2025) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20250615 · Cited by 3
Position Statement on Cardiometabolic Health Across the Woman's Life Course – 2025
de Oliveira, G. M. M., de Almeida, M. C. C., Valério, C. M., Giuffrida, F. M. A., Espíndola, L. N., Izar, M. C. D. O., Marques-Santos, C., Freire, C. M. V., Albuquerque, C. J. D. M., Chagas, A. C. P., et al. (2025) · Revista Brasileira Ginecologia e Obstetrícia · doi:10.61622/rbgo/2025rbgo200 · Cited by 2
Sistanizad, M., Taherpour, N., Alibeigi, P., Sadeghi, S., Shamizadehkalkhoran, M., & Moradi, O. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-04524-4 · Cited by 1
“Previous long-term studies, such as that of Lassailly et al., have shown that regression of fibrosis is often a gradual process that may require several years to become evident [19].”
Zhang, H., Liu, P., Deng, Y., Wu, L., Fan, O. R., Cui, Y., Zhang, C., Zhu, W., Sun, Y. E., Lin, C., et al. (2025) · Stem Cell Research & Therapy · doi:10.1186/s13287-025-04855-9 · Cited by 1
“Although bariatric surgery has shown therapeutic effects for NAFLD [2, 3], its effectiveness is frequently compromised by challenges related to patient compliance and the limited availability of comprehensive clinical evidence supporting its long-term benefits.”
Schwartz, A. W., Park, E. Y., Ilagan‐Ying, Y. C., Zimmerman, Z., Bollinger, B., Ying, L., Deng, Y., Duffy, A. J., Morton, J. M., Mehal, W. Z., et al. (2026) · World Journal of Hepatology · doi:10.4254/wjh.v18.i1.113753 · Cited by 1
Chen, S., Gao, Y., Cheng, G., Meng, F., Zheng, Y., Zhang, B., Chen, J., Zhang, Y., Yin, Z., Yang, H., et al. (2026) · Hepatology International · doi:10.1007/s12072-026-11051-1 · Cited by 2
Ratziu, V., Petitjean, L., Pais, R., Aron‐Wisnewsky, J., Charlotte, F., Bédossa, P., Thabut, D., Kara, L., Clément, K., & Petitjean, M. M. (2026) · Hepatology Communications · doi:10.1097/hc9.0000000000000900 · Cited by 1
A transdisciplinary framework for managing metabolic dysfunction associated steatotic liver disease
Kouser, S., Sharma, S. V., Bhanu, A., Kukkupuni, S. K., & Vishnuprasad, C. N. (2026) · Frontiers in Pharmacology · doi:10.3389/fphar.2026.1767844 · Cited by 2
“They often require multi-speciality care including hepatologists, endocrinologists, cardiologists, and dietitians (Fakhry et al., 2019; Lassailly et al., 2020; Aminian et al., 2021).”
PLAKIDA, A. L., Юшковська, О., & Sierpińska, L. E. (2026) · World Journal of Hepatology · doi:10.4254/wjh.v18.i3.113284 · Cited by 1
Alzaki, A. A., Alqahtani, M., Aman, E., Asiri, G. M., Jibril, M. H. A., Desoky, R. M., Alqahtani, S. A., Suhaqi, L., Alkhalid, S. A., Alshareef, D. Y., et al. (2026) · Cureus · doi:10.7759/cureus.106038 · Cited by 2
Lifespan approaches for the prevention and management of steatotic liver disease
Zelber‐Sagi, S., Ivancovsky-Wajcman, D., Kugelmas, C., Weinstein, A. A., Wong, V. W., Castéra, L., Moore, J. B., Mouzaki, M., Hallsworth, K., Paik, J. M., et al. (2026) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-026-01198-5 · Cited by 1
Romeo, M., Basile, C., Martinelli, G., Nardo, F. D., Napolitano, C., Gregorio, A. D., Vaia, P., Puorto, L. D., Indipendente, M., Federico, A., et al. (2026) · Cancers · doi:10.3390/cancers18081316 · Cited by 1
Zhang, H., Jiang, Z., Zheng, H., Wang, H., Xia, L., Chen, J. M., & Zhang, B. Y. (2026) · BMC Gastroenterology · doi:10.1186/s12876-026-04914-2 · Cited by 1
“This surgical intervention can mitigate liver inflammation and fibrosis at the histological level and reduce the risk of T2DM-related macrovascular complications [15, 16].”
Wen, M.-C., Li, J.-Y., Sun, Q., Hu, C., Ju, S., Tian, F., Chen, B., Li, C., Liu, Y., Zhou, J., et al. (2026) · Journal of Chromatography B · doi:10.1016/j.jchromb.2026.125126 · Cited by 1
Mahoon, D. A., Kellany, F., Khan, I., Khan, S., & Butler, A. E. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27125618 · Cited by 2
“Bariatric surgery provides an informative comparison because it produces substantially greater weight loss than currently achievable with GLP-1 receptor agonists and has demonstrated significant benefits in hepatic steatosis and steatohepatitis [44,45].”
Fallowfield, J. A., Ramachandran, P., & Kendall, T. J. (2026) · Journal of Hepatology · doi:10.1016/j.jhep.2026.05.026 · Cited by 2
Tuffs, C., Saleh, N. A., Hauenschild, A., Sauerbier, L., Amin, D., Kosovic, A., Amati, A., Albrecht, J. U., Askevold, I. H., Karrasch, T., et al. (2026) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2026.07.016 · Cited by 1
Cho, Y. (2026) · Journal of Korean Medical Association · doi:10.5124/jkma.26.0056 · Cited by 1
“다만 간섬유화 개선은 지방증이 나 염증 호전에 비해 상대적으로 더 오랜 시간이 필요하며, 장기 적인 체중감량 유지 여부와 밀접한 관련이 있는 것으로 알려져 있다[ 21 ].”
Plauth, M. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-98368-6.00004-5 · Cited by 1
The Role of Bariatric Surgery in Fatty Liver
Geerts, A. M., & Lefere, S. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.96975 · Cited by 1
Vitamin D Status and Steatohepatitis in Obese Diabetic and Non-Diabetic Patients
Taban, L., Stoian, D. L., Timar, B., Amzăr, D., Adela, C., Motofelea, A. C., Borlea, A., Frisoni, R., & Laguerre, N. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11185482 · Cited by 1
“Bariatric surgery on MAFLD has presented beneficial effects, improving histological results, as stated in some studies, with a resolution of NASH in 75% of cases, a further reduction in fibrosis in 35% of patients [9,10], and a partial reversion of cirrhosis; these results were not achieved with other treatment, such…”
Patient Selection in Bariatric Surgery
Sarkar, R. (2023) · Springer eBooks · doi:10.1007/978-3-030-60596-4_8 · Cited by 1
Enfermedad por esteatohepatitis no alcohólica en pacientes diabéticos tipo 2: artículo de revisión
Miranda, G. (2023) · Horizonte Médico (Lima) · doi:10.24265/horizmed.2023.v23n2.13 · Cited by 1
Roberts, R., Williams, D. M., Min, T., Barry, J. D., & Stephens, J. W. (2023) · Journal of Diabetes & Metabolic Disorders · doi:10.1007/s40200-023-01311-4 · Cited by 1
“One prospective study reported NASH resolution in 85% of patients undergoing bariatric surgery after 1 year [26], and in 84% of patients after 5 years [27] using histopathological samples.”
BackgroundNAFLD and type 2 diabetes: A practical guide for the joint management
Genua, I., Iruzubieta, P., Rodríguez-Duque, J. C., Pérez, A., & Crespo, J. (2023) · Gastroenterología y Hepatología (English Edition) · doi:10.1016/j.gastre.2022.12.010 · Cited by 1
Can Surgeons Reliably Identify Non-cirrhotic Liver Disease During Laparoscopic Bariatric Surgery?
Wuopio, A., Baker, B. M., Koethe, B. C., Goodman, M. D., Shin, R. D., Bugaev, N., Nepomnayshy, D., Kim, W. C., & Schnelldorfer, T. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07070-2 · Cited by 1
“Such findings emphasize the need for post-operative surveillance once NAFLD is identified [24–26].”
Integrator complex subunit 6 promotes hepatocellular steatosis via β-catenin-PPARγ axis
Shiozaki, M., Kanno, K., Yonezawa, S., Otani, Y., Shigenobu, Y., Haratake, D., Murakami, E., Oka, S., & Ito, M. (2024) · Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids · doi:10.1016/j.bbalip.2024.159532 · Cited by 1
Zhang, Y., & Xu, C. (2024) · Journal of Biosciences and Medicines · doi:10.4236/jbm.2024.1211015 · Cited by 1
Poynard, T., Deckmyn, O., Pais, R., Aron‐Wisnewsky, J., Peta, V., Bédossa, P., Charlotte, F., Ponnaiah, M., Siksik, J., Siksik, J.-M., et al. (2025) · Diagnostics · doi:10.3390/diagnostics15101253 · Cited by 1
“…BARiatric study of the foundation for Innovation in CArdiometabolism and Nutrition (BARICAN) cohort, including 55 patients before and after BS [5], as summarized in Supplementary File S1 and Figure S2; (2) the prospective QuidNash consortium (https: //rhu-quidnash.com/about-the-project/,…”
Fat: bariatric surgery and procedures
McGowan, B. M. (2022) · British Journal of Diabetes · doi:10.15277/bjd.2022.368 · Cited by 1
Effect of Metabolic Surgery on Non-Alcoholic Steatohepatitis
Fearon, N. M., & Pournaras, D. J. (2023) · Springer eBooks · doi:10.1007/978-3-030-60596-4_107 · Cited by 1
Avenir de la chirurgie bariatrique au-delà de la surcharge pondérale : la chirurgie métabolique
Caiazzo, R. J., Marciniak, C., Rémond, A., Baud, G., & Pattou, F. N. (2023) · Journal de Chirurgie Viscérale · doi:10.1016/j.jchirv.2023.01.002 · Cited by 1
Self-citationVoies thérapeutiques dans l’hépatopathie stéatosique métabolique
Smati, S., Canivet, C. M., Boursier, J., & Cariou, B. (2023) · Médecine des Maladies Métaboliques · doi:10.1016/j.mmm.2023.03.007 · Cited by 1
The Weighty Issue of Treating Obesity in Patients With Nonalcoholic Fatty Liver Disease
Adams, L. A. (2021) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2021.06.021 · Cited by 1
Chisthi, M. M. (2024) · World Journal of Gastroenterology · doi:10.3748/wjg.v30.i20.2629 · Cited by 1
“Furthermore, the importance of lifestyle interventions in the context of NAFLD extends beyond hepatic implications and has the potential to address associated metabolic risk factors, such as obesity, insulin resistance, and dyslipidemia[14, 15].”
Onoiu, A.-I., Murray, L., Gerardin, Y., Singh, G., Egger, R., González-Serrano, S., Cambra-Cortés, V., Jiménez-Franco, A., Guilarte, C., Parada, D., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-8725050/v1 · Cited by 1
La stéatopathie dysmétabolique
Zampaglione, L., Ferrari, J., & Goossens, N. (2020) · Schweizer Gastroenterologie · doi:10.1007/s43472-020-00018-8
Metabolische Chirurgie, mehr als nur Typ-2-Diabetes
Rühle, A., Bošković, A., Billeter, A., Schwarz, A.-C., & Müller-Stich, B. (2020) · Adipositas - Ursachen Folgeerkrankungen Therapie · doi:10.1055/a-1267-8215 · Cited by 1
“Im Langzeitverlauf nach fünf Jahren haben sich diese Ergebnisse bestätigt, und der Rückgang der Fibrose bei Patienten mit manifester NASH nimmt im Langzeitverlauf sogar weiter zu [26].”
BackgroundRiveros, S., Inzunza, M., Crovari, F. J., Briceño, E., Achurra, P., & Quezada, N. (2021) · Obesity Surgery · doi:10.1007/s11695-020-05203-x
Editorial for “Automated Analysis of Multiparametric MRI / MRE Exams for Prediction of NASH ”
Torkzad, M. R. (2021) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.27540
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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