Original ResearchFull Report: Clinical—LiverBariatric Surgery Provides Long-term Resolution of Nonalcoholic Steatohepatitis and Regression of Fibrosis
Graphical abstract
Section snippets
Outcomes
The primary outcome of our study was the resolution of NASH with no worsening of fibrosis 5 years after surgery. The secondary outcomes were (1) improvement in fibrosis (reduction of ≥1 stage) at 5 years, and (2) progression of NASH and fibrosis, compared with baseline, at 1 and 5 years. Fibrosis stage 1a, 1b, and 1c were considered to be stage 1 for the statistical analysis. Other secondary outcomes included changes from baseline to 5 years in serum aminotransferase, γ-glutamyltranspeptidase,
Cohort Patients
Of the patients enrolled in the Lille bariatric cohort at analysis, 180 presented with liver specimen-proven NASH at surgery (Figure 1). This NASH cohort mainly included women, mean age of 46.7 years, with a median fibrosis score of 2 (IQR, 1–3). Patient characteristics are summarized in Table 1. The main surgical procedure was gastric bypass (66.1%) (Supplementary Table 1).
During the 5-year follow-up, 3 patients died of nonliver-related causes, including 2 deaths from surgical complications
Discussion
In this long-term prospective study with consecutive liver biopsies, bariatric surgery induced the resolution of NASH without worsening of fibrosis in 84% of patients at 5 years. Long-term resolution of NASH led to the regression of fibrosis in 70% of patients. The resolution of NASH occurred within the first year and was maintained over the 5-year period, whereas fibrosis began to improve within 1 year and continued throughout the 5-year follow-up.
With an 80% success rate for the resolution of
Conclusion
This prospective 5-year follow-up of obese NASH patients showed that the beneficial effects of bariatric surgery on the resolution of NASH were durable and led to a sustained reduction in fibrosis over 5 years.
Acknowledgments
The authors gratefully acknowledge Shirley Balik, Marie Clement, Aurelie Lobez, and Sarah Surmont, for their daily work on prospective data collection. The authors acknowledge Dr D. Buob and Dr B. Bouchindhomme for their work and implication in the analysis of liver biopsy specimens.
CRediT Authorship Contributions
Guillaume Lassailly, MD (Data curation: Equal; Formal analysis: Equal; Investigation:
Equal; Methodology: Equal; Writing – original draft: Lead; Writing – review & editing:
Equal); Robert Caiazzo, MD, PhD
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Conflicts of interest The authors disclose no conflicts.
Funding This work was supported by grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique) and from the Conseil Régional Nord-Pas de Calais (ARCIR Obésité et Alcool), Agence National de la Recherche (European Genomic Institute for Diabetes [EGID], ANR-10-LABX-46, PreciNASH, ANR-16-RHUS-0006), and the European commission (FEDER).