Digestive Diseases and Sciences

, Volume 63, Issue 7, pp 1946–1951 | Cite as

Long-Term Follow-Up Study of Liver-Related Outcome After Bilio-Pancreatic Diversion in Patients with Initial, Significant Liver Damage

  • Edoardo G. Giannini
  • Claudia Coppo
  • Chiara Romana
  • Giovanni B. Camerini
  • Franco De Cian
  • Nicola Scopinaro
  • Francesco S. Papadia
Original Article



Obesity is associated with NAFLD, and bariatric surgery has significant impact on this liver disease, with reported improvement in hepatic fibrosis.


To investigate the effects of bariatric surgery on long-term liver disease-related outcome in obese patients with nonalcoholic fatty liver disease (NAFLD) and significant liver damage.


This study included 56 NAFLD patients who underwent bilio-pancreatic diversion for morbid obesity and who had significant fibrosis at intraoperative liver biopsy. Data were analyzed at 1, 3, and 5 years of follow-up, and at the latest available visit in patients who had longer follow-up. We assessed the incidence of clinically relevant liver events (ascites, hepatic encephalopathy, portal hypertension-related bleeding, and jaundice) as well as modifications of a validated biochemical index such as the NAFLD score.


During a median follow-up of 78 months, median weight decreased from 119 to 78 kg (P < 0.0001), and median body mass index decreased from 45.2 to 29.0 kg/m2 (P < 0.0001). None of the patients developed clinical complications of liver disease, and none died due to liver-related causes. Median NAFLD score significantly decreased (P = 0.0005) during follow-up from − 0.929 (− 1.543 to − 0.561) to − 1.609 (− 2.056 to − 1.102). The NAFLD score category was unchanged in 32 patients (57%), improved in 18 (32%), and worsened in 6 (11%).


Patients with NAFLD and proven histological liver damage at surgery do not develop complications of liver disease in long term after bilio-pancreatic diversion. Moreover, noninvasive parameters of liver damage improve. Thus, preexisting liver damage does not seem to be a contraindication to bilio-pancreatic diversion.


Liver fibrosis Steatosis Nonalcoholic fatty liver disease Cirrhosis Bariatric surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Edoardo G. Giannini
    • 1
  • Claudia Coppo
    • 1
  • Chiara Romana
    • 1
  • Giovanni B. Camerini
    • 2
  • Franco De Cian
    • 2
  • Nicola Scopinaro
    • 2
  • Francesco S. Papadia
    • 2
  1. 1.Gastroenterology Unit, Department of Internal Medicine, Ospedale Policlinico IRCCS San MartinoUniversity of GenoaGenoaItaly
  2. 2.Functional and Metabolic Surgery Unit, Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico IRCCS San MartinoUniversity of GenoaGenoaItaly

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