Sleeve Gastrectomy Is Associated with a Greater Reduction in Plasma Liver Enzymes Than Bypass Surgeries—A Registry-Based Two-Year Follow-Up Analysis
Open accessAbstract
Bariatric surgeries may lead to an improvement in metabolic fatty liver disease, and a reduction in the levels of the hepatic enzyme Alanine Aminotransferase (ALT). We compared the effects of Sleeve Gastrectomy (SG), Roux en Y Gastric Bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) on the levels of ALT by analysis of two-year follow-up data from 4980 patients in the Israeli Bariatric Registry that included laboratory tests and demographic information. Pre-operative characteristics of patients, and particularly levels of liver enzymes, were similar across surgery types. Regression modeling and retrospective matching showed that SG was superior to RYGB and OAGB in reducing ALT levels, and in reducing the fraction of patients with abnormally high ALT levels. Two-year post-surgery, an increase in ALT levels from normal to abnormal levels was observed in 5% of SG patients, and in 18% and 23% of RYGB and OAGB patients. In conclusion, SG leads to a greater reduction in ALT levels compared with bypass surgeries and a lower incidence of post-surgical elevation of ALT levels. Further studies are required to identify the cause for the rise in liver enzymes, and to determine whether ALT levels correlate with liver pathology especially following bariatric surgery.
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VSG outperforms RYGB in ALT reduction at two years.
“In contrast, VSG outperformed RYGB at two years, achieving a 32.1% reduction compared to 15.4% with RYGB [112,113].”
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 [113]
The Results (§3.3) and Conclusions (§5; page numbers unavailable) report that sleeve gastrectomy produced lower ALT levels than RYGB at two years and the greatest ALT reduction. The cited paper does not substantiate the citing sentence’s specific 32.1% versus 15.4% reductions. (LLM, conf=0.86)
Experimental — accuracy not yet measuredRYGB reduces ALT by 15.4% at two years.
“In contrast, VSG outperformed RYGB at two years, achieving a 32.1% reduction compared to 15.4% with RYGB [112,113].”
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 [113]
Results §3.2 reports that median ALT fell after all three surgeries, including RYGB, at two years. Results §3.3 also finds a greater reduction with sleeve gastrectomy than with RYGB. Our copy does not report the claimed 15.4% reduction for RYGB. (LLM, conf=0.85)
Experimental — accuracy not yet measuredVSG reduces ALT by 32.1% at two years.
“In contrast, VSG outperformed RYGB at two years, achieving a 32.1% reduction compared to 15.4% with RYGB [112,113].”
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 [113]
Results §3.2 and the Conclusions (page numbers unavailable) report that sleeve gastrectomy produced a greater reduction in ALT than RYGB at two years. Our copy does not report a 32.1% ALT reduction for sleeve gastrectomy or the cited 15.4% figure for RYGB, so the numerical comparison is unsupported. (LLM, conf=0.86)
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- Authors
- Azulai, S., Grinbaum, R., Beglaibter, N., Eldar, S. M., Rubin, M., Ben-Haroush Schyr, R., Romano-Zelekha, O., & Ben-Zvi, D.
- Affiliations
- Hebrew University of Jerusalem (IL)
- Hadassah Medical Center (IL)
- Tel Aviv University (IL)
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, The Hebrew University of Jerusalem-Hadassah Medical School, Jerusalem 91120, Israel
- Israel Center for Disease Control, Ministry of Health, Ramat Gan 52621, Israel
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2021-03-09
- Volume
- 10
- Issue
- 5
- Pages
- 1144
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC7967238
- OpenAlex
- W3134360255
- Cited by
- 13
- References
- 45
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 3
- FWCI
- 2.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- European Research Council (803526)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- sleeve gastrectomy, Roux-en-Y gastric bypass, one anastomosis gastric bypass, bariatric surgery, alanine aminotransferase, liver enzymes, obesity
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