Advertisement

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
  • 96 Downloads

Abstract

Background

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

Aims

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.

Methods

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.

Results

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%).

Conclusions

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.

Keywords

Liver fibrosis Steatosis Nonalcoholic fatty liver disease Cirrhosis Bariatric surgery 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Satapathy SK, Sanyal AJ. Epidemiology and natural history of nonalcoholic fatty liver disease. Semin Liver Dis. 2015;35:221–235.CrossRefPubMedGoogle Scholar
  2. 2.
    Italian Association for the Study of the Liver (AISF). AISF position paper on nonalcoholic fatty liver disease (NAFLD): updates and future directions. Dig Liver Dis. 2017;49:471–483.CrossRefGoogle Scholar
  3. 3.
    Ekstedt M, Hagström H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61:1547–1554.CrossRefPubMedGoogle Scholar
  4. 4.
    Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34:274–285.CrossRefPubMedGoogle Scholar
  5. 5.
    Doycheva I, Issa D, Watt KD, et al. Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in young adults in the United States. J Clin Gastroenterol. 2017.  https://doi.org/10.1097/MCG.0000000000000925.Google Scholar
  6. 6.
    Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indication for liver transplantation in patients with hepatocellular carcinoma in the US. Hepatology. 2014;59:2188–2195.CrossRefPubMedGoogle Scholar
  7. 7.
    Petta S, Gastaldelli A, Rebelos E, et al. Pathophysiology of non alcoholic fatty liver disease. Int J Mol Sci. 2016;17:E2082.CrossRefPubMedGoogle Scholar
  8. 8.
    Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149:367–378.CrossRefPubMedGoogle Scholar
  9. 9.
    Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137:532–540.CrossRefPubMedGoogle Scholar
  10. 10.
    Dixon JB, Bhathal PS, Hughes NR, et al. Nonalcoholic fatty liver disease: improvement in liver histological analysis with weight loss. Hepatology. 2004;39:1647–1654.CrossRefPubMedGoogle Scholar
  11. 11.
    Alizai PH, Wendl J, Roeth AA, et al. Functional liver recovery after bariatric surgery—a prospective cohort study with the LiMAx Test. Obes Surg. 2015;25:2047–2053.CrossRefPubMedGoogle Scholar
  12. 12.
    Lowell JA, Shenoy S, Ghalib R, et al. Liver transplantation after jejunoileal bypass for morbid obesity. J Am Coll Surg. 1997;185:123–127.CrossRefPubMedGoogle Scholar
  13. 13.
    Hocking MP, Davis GL, Franzini DA, et al. Long-term consequences after jejunoileal bypass for morbid obesity. Dig Dis Sci. 1998;43:2493–2499.CrossRefPubMedGoogle Scholar
  14. 14.
    Cazzo E, Jimenez LS, Pareja JC, et al. Effect of Roux-en-y gastric bypass on nonalcoholic fatty liver disease evaluated through NAFLD fibrosis score: a prospective study. Obes Surg. 2015;25:982–985.CrossRefPubMedGoogle Scholar
  15. 15.
    Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;13:48–58.CrossRefGoogle Scholar
  16. 16.
    Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T, et al. Bariatric surgery for nonalcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev. 2010;1:CD007340.Google Scholar
  17. 17.
    Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases. American College of Gastroenterology, and the American Gastroenterological Association. Am J Gastroenterol. 2012;107:811–826.CrossRefPubMedGoogle Scholar
  18. 18.
    Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–854.CrossRefPubMedGoogle Scholar
  19. 19.
    Papadia FS, Marinari GM, Camerini G, et al. Liver damage in severely obese patients: a clinical–biochemical–morphologic study on 1000 liver biopsies. Obes Surg. 2004;14:952–958.CrossRefPubMedGoogle Scholar
  20. 20.
    American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2005;28:S37–S42.CrossRefGoogle Scholar
  21. 21.
    Simo KA, Mckillop IH, McMillan MT, et al. Does a calculated “NAFLD fibrosis score” reliably negate the need for liver biopsy in patients undergoing bariatric surgery? Obes Surg. 2014;24:15–21.CrossRefPubMedGoogle Scholar
  22. 22.
    Qureshi K, Clements RH, Abrams GA. The utility of the “NAFLD fibrosis score” in morbidly obese subjects with NAFLD. Obes Surg. 2008;18:264–270.CrossRefPubMedGoogle Scholar
  23. 23.
    Machado MV, Cortez-Pinto H. Non-invasive diagnosis of nonalcoholic fatty liver disease. A critical appraisal. J Hepatol. 2013;58:1007–1019.CrossRefPubMedGoogle Scholar

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

Personalised recommendations