Roux-en-Y Gastric Bypass Versus Adjustable Gastric Banding to Reduce Nonalcoholic Fatty Liver Disease: A 5-Year Controlled Longitudinal Study
Abstract
In Brief Objectives: To compare the long-term benefit of gastric bypass [Roux-en-Y gastric bypass (RYGB)] versus adjustable gastric banding (AGB) on nonalcoholic fatty liver disease (NAFLD) in severely obese patients. Background: NAFLD improves after weight loss surgery, but no histological study has compared the effects of the various bariatric interventions. Methods: Participants consisted of 1236 obese patients (body mass index = 48.4 ± 7.6 kg/m2), enrolled in a prospective longitudinal study for up to 5 years after RYGB (n = 681) or AGB (n = 555). Liver biopsy samples were available for 1201 patients (97.2% of those at risk) at baseline, 578 patients (47.2%) at 1 year, and 413 patients (68.9%) at 5 years. Results: At baseline, NAFLD was present in 86% patients and categorized as severe [NAFLD activity score (NAS) ≥3] in 22% patients. RYGB patients had a higher body mass index (49.8 ± 8.2 vs 46.8 ± 6.5 kg/m2, P < 0.001) and more severe NAFLD (NAS: 2.0 ± 1.5 vs 1.7 ± 1.4, P = 0.004) than AGB patients. Weight loss at 5 years was 25.5% ± 11.8% after RYGB versus 21.4% ± 12.7% after AGB (P < 0.001). When analyzed with a mixed model, all NAFLD parameters improved after surgery (P < 0.001) and improved significantly more after RYGB than after AGB [steatosis (%): 1 year, 7.9 ± 13.7 vs 17.9 ± 21.5, P < 0.001/5 years, 8.7 ± 7.1 vs 14.5 ± 20.8, P < 0.05; NAS: 1 year, 0.7 ± 1.0 vs 1.1 ± 1.2, P < 0.001/5 years, 0.7 ± 1.2 vs 1.0 ± 1.3, P < 0.05]. In multivariate analysis, the superiority of RYGB was primarily but not entirely explained by weight loss. Conclusions: The improvement of NAFLD was superior after RYGB than after AGB. We enrolled 1236 obese patients in a longitudinal study with sequential liver biopsies before and after gastric bypass [Roux-en-Y gastric bypass (RYGB)] or gastric banding [adjustable gastric banding (AGB)]. Nonalcoholic fatty liver disease improved from baseline to 5 years after both interventions but more significantly after RYGB than after AGB. In multivariate analysis, the superiority of RYGB was primarily but not entirely explained by weight loss.
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AGB improves steatosis in 41.9% of patients.
“AGB also improved steatosis (41.9%), although RYGB showed greater efficacy (76.2%) [119].”
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 [119]
RYGB improves steatosis in 76.2% of patients.
“AGB also improved steatosis (41.9%), although RYGB showed greater efficacy (76.2%) [119].”
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 [119]
RYGB is more effective than AGB for steatosis improvement.
“AGB also improved steatosis (41.9%), although RYGB showed greater efficacy (76.2%) [119].”
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 [119]
AGB improves NAS by 35.3%.
“AGB showed modest NAS improvement (35.3%) [119].”
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 [119]
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- Authors
- Caiazzo, R., Lassailly, G., Leteurtre, E., Baud, G., Verkindt, H., Raverdy, V., Buob, D., Pigeyre, M., Mathurin, P., & Pattou, F.
- Affiliations
- Inserm (FR)
- Centre Hospitalier Universitaire de Lille (FR)
- Corresponding author
- Caiazzo, Robert
- Verkindt, Hélène
- Raverdy, Violeta
- Pattou, François
- ORCID
- Venue
- Annals of Surgery
- Published
- 2014-11
- Volume
- 260
- Issue
- 5
- Pages
- 893-899
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2332106446
- Cited by
- 226
- References
- 21
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 11 · 2023: 15 · 2022: 25 · 2021: 31 · 2020: 27 · 2019: 24 · 2018: 22 · 2017: 20 · 2016: 18 · 2015: 20 · 2014: 1
- FWCI
- 19.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of 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 › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- Roux-en-Y gastric bypass, gastric banding, non-alcoholic fatty liver disease, bariatric surgery, morbid obesity, liver histopathology, NAFLD activity score, hepatic steatosis, liver fibrosis, weight loss, long-term outcomes, liver biopsy histology, NAFLD progression
- MeSH terms
- Biopsy, Female, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Morbid, Prospective Studies, Gastric Bypass, Gastroplasty, Body Mass Index, Treatment Outcome, Non-alcoholic Fatty Liver Disease
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