Bariatric surgery was found to induce non-alcoholic steatohepatitis (NASH) resolution without worsening fibrosis in patients with severe obesity, according to 5-year follow-up data from a prospective study published in Gastroenterology.

Little is known about the long-term effects of bariatric surgery for patients with NASH; therefore, the researchers evaluated sequential liver samples collected at the time of bariatric surgery and at 1 and 5 years later, to assess the long-term effects of bariatric surgery in 180 patients with severe obesity and biopsy-proven NASH. The patients underwent bariatric surgery at a single center in France.

At 5 years after bariatric surgery, the operative intervention resolved NASH in samples from 84% of patients (n=64; 95% CI, 73.1%-92.2%). Fibrosis decreased from baseline in samples from 70.2% of patients (95% CI, 56.6%-81.6%) and disappeared from samples from 56% of all patients (95% CI, 42.4%-69.3%). Fibrosis also disappeared in samples from 45.5% of patients with baseline bridging fibrosis.


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The persistence of NASH was associated with no decrease in fibrosis and less weight loss. The reductions in body mass index for patients with persistent NASH (6.3 ± 4.1 kg/m2) were different for patients with NASH resolution (13.4 ± 7.4 kg/m2; P =.017).

NASH resolution was observed 1 year after bariatric surgery in biopsies from 84% of patients, with no significant recurrence between 1 and 5 years (P =.17). Fibrosis began to decrease by 1 year after surgery and continued to decrease until 5 years (P <.001).

The length of the liver specimens used during this analysis could be considered a study limitation, according to the investigators, because a length of 2 to 3 cm is typically recommended. The study took a “conservative approach” to biopsies and required specimens at least 8 mm long, “which is longer than the minimal length proposed by expert guidelines,” the study authors said.

Nevertheless, “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,” they concluded.

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Reference

Lassailly G, Caiazzo R, Ntandja-Wandji L-C, et al. Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis. Gastroenterology. 2020;159(4):1290-1301. doi: 10.1053/j.gastro.2020.06.006