Surgical Treatment of Non-Alcoholic Steatohepatitis and Non-Alcoholic Fatty Liver Disease
Abstract
Background: Overweight and obesity are the most significant risk factors for the development of hepatic steatosis, non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver disease (NAFLD) in children and adults. Both have been increasingly implicated in the genesis of hepatic fibrosis and cirrhosis. However, no consensus exists about whether weight reduction may reverse this process. Methods: To assess the effect of obesity surgery on the histological evolution of NASH, diagnosed in 284 morbidly obese patients by routine liver biopsy (‘first’ biopsy) performed during bariatric surgery, we performed a ‘second’ biopsy after 18.6 ± 8.3 months in 116 patients (109 female, 7 male). 68 patients underwent Roux-en-Y gastric bypass, 38 adjustable gastric banding and 16 biliopancreatic diversion with duodenal switch (BPD-DS). The second biopsy was taken during CHE (102) and relaparoscopy for suspected complications and revisional surgeries (12). All primary and secondary surgical procedures were done laparoscopically without intraoperative or postoperative major complications. All comorbidities were recorded pre- und postoperatively. Results: From the first to the second biopsy, BMI decreased from 55.2 ± 8.3 to 30.5 ± 6.6 kg/m 2, arterial hypertension decreased from 65 to 43%, and type 2 diabetes decreased from 42 to 2%. On the first biopsy, non-alcoholic fatty liver disease (NAFLD) type 3 was observed in 186 patients (65.5%) and type 4 in 82 (28.9%). The second biopsy revealed complete regression of NAFLD in 89 patients (82.8%) and only 16 (13.8%) still had NAFLD type 1 (mild steatosis without inflammation). These two patients with NAFLD type 3 had adjustable gastric banding with insufficient weight loss (EWL <50%) in history. Complete regression of necroinflammatory activity was observed in 108 patients (93.1%). Among the 12 patients presenting fibrosis in the first biopsy, complete remission was observed in 10 and improvement in 2. Two patients with ascites during BPD-DS showed complete remission within 9–15 months. Two continued to show the same degree of fibrosis without evidence of disease activity. No worsening of steatosis, necroinflammatory activity or fibrosis was observed in any of the patients, and none progressed to cirrhosis. Conclusion: Obesity surgery improves steatosis, necroinflammatory activity and hepatic fibrosis in patients with morbid obesity and NASH. The improvement of all obesity-related comorbidities can be confirmed.
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BPD-DS achieves superior weight loss compared with RYGB, with mean BMI reductions of approximately 24.8 kg/m2 versus approximately 17.3 kg/m2 (p < 0.001).
“BPD-DS achieves superior weight loss compared to RYGB, with mean BMI reductions of ~24.8 kg/m2 versus ~17.3 kg/m2, respectively (p < 0.001) [54,61,62,63].”
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 [54]
BPD-DS achieves high rates of type 2 diabetes remission.
“and it achieves high rates of type 2 diabetes remission, addressing a key driver of NAFLD [51,54].”
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 [54]
Weiner et al. showed that ten of twelve (83%) patients achieved complete remission in fibrosis after BPD-DS, and the remaining two showed improvements.
“Additionally, Weiner et al. had shown that ten patients out of twelve (83%) achieved complete remission in fibrosis, and the remaining two showed improvements [54].”
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 [54]
BPD-DS leads to resolution of steatohepatitis in a majority of patients and can regress advanced disease.
“Accordingly, BPD-DS leads to resolution of steatohepatitis in a majority of patients and can even regress advanced disease [53,54,55].”
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 [54]
In a multicenter study of 284 patients, MASLD severity improved in 93.7% overall.
“A multicenter study of 284 patients found MASLD severity improved in 93.7% overall—highest with BPD-DS (100%), followed by RYGB (88.2%) and AGB (61.9%) [54].”
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 [54]
BPD-DS yields 100% MASLD severity improvement.
“A multicenter study of 284 patients found MASLD severity improved in 93.7% overall—highest with BPD-DS (100%), followed by RYGB (88.2%) and AGB (61.9%) [54].”
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 [54]
RYGB yields 88.2% MASLD severity improvement.
“A multicenter study of 284 patients found MASLD severity improved in 93.7% overall—highest with BPD-DS (100%), followed by RYGB (88.2%) and AGB (61.9%) [54].”
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 [54]
AGB yields 61.9% MASLD severity improvement.
“A multicenter study of 284 patients found MASLD severity improved in 93.7% overall—highest with BPD-DS (100%), followed by RYGB (88.2%) and AGB (61.9%) [54].”
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 [54]
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REVIEW ARTICLE: BARIATRIC SURGERY FOR OBESITY AND DIABETES
Azizi, F. (2013)
- Authors
- Weiner, R. A.
- Affiliations
- Krankenhaus Sachsenhausen (DE)
- Corresponding author
- Weiner, R.A.
- Venue
- Digestive Diseases
- Publisher
- S. Karger AG
- Published
- 2010
- Volume
- 28
- Issue
- 1
- Pages
- 274-279
- ISSN
- 0257-2753 (ISSN-L)
- 1421-9875
- OpenAlex
- W2097975792
- Cited by
- 113
- References
- 15
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 4 · 2021: 8 · 2020: 5 · 2019: 9 · 2018: 8 · 2017: 11 · 2016: 6 · 2015: 12 · 2014: 6 · 2013: 13 · 2012: 13
- FWCI
- 11.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Digestive Diseases (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 › Organ Transplantation Techniques and Outcomes
- Keywords
- nonalcoholic steatohepatitis, non-alcoholic fatty liver disease, bariatric surgery, Roux-en-Y gastric bypass, gastric banding, biliopancreatic diversion with duodenal switch, morbid obesity, hepatic steatosis, liver fibrosis, liver biopsy histology, weight loss, hepatic necroinflammation, liver cirrhosis
- MeSH terms
- Adult, Fatty Liver, Female, Humans, Liver, Male, Middle Aged, Obesity, Morbid, Weight Loss, Bariatric Surgery
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