1. Liver Function in Patients With Nonalcoholic Fatty Liver Disease Randomized to Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy
- Author
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Bogna Ziarkiewicz-Wróblewska, Mariusz Grodzicki, Tadeusz Wróblewski, Piotr Remiszewski, Rafał Paluszkiewicz, Marek Krawczyk, and Piotr Kalinowski
- Subjects
Adult ,Male ,medicine.medical_specialty ,Sleeve gastrectomy ,medicine.medical_treatment ,Gastric Bypass ,030209 endocrinology & metabolism ,Gastroenterology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Liver Function Tests ,Randomized controlled trial ,Gastrectomy ,Non-alcoholic Fatty Liver Disease ,law ,Internal medicine ,Nonalcoholic fatty liver disease ,medicine ,Humans ,Postoperative Period ,Prospective Studies ,Aged ,medicine.diagnostic_test ,business.industry ,Fatty liver ,nutritional and metabolic diseases ,Middle Aged ,medicine.disease ,Roux-en-Y anastomosis ,Obesity, Morbid ,Treatment Outcome ,Liver ,Female ,030211 gastroenterology & hepatology ,Surgery ,Liver function ,Liver function tests ,business ,Follow-Up Studies - Abstract
The aim of the study was to compare the influence of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) on liver function in bariatric patients with non-alcoholic fatty liver disease (NAFLD) in a randomized clinical trial (NCT01806506).Rapid weight loss and malabsorption after bariatric surgery in patients with NAFLD or steatohepatitis (NASH) may impair liver function.Sixty-six morbidly obese patients randomized to SG or RYGB were included in a secondary outcome analysis. Intraoperative liver biopsies were categorized with NAFLD Activity Score (NAS) and liver function tests were done before surgery and after 1, 6 and 12 months.NASH was present in 54.5% RYGB and 51.5% SG patients (P0.05). At 12 months excess weight loss was 68.7 ± 19.7% after SG and 62.8 ± 18.5% after RYGB (P0.05). At 1 month international normalized ratio (INR) increased after RYGB (0.98 ± 0.05 vs 1.14 ± 0.11; P0.05) and SG (0.99 ± 0.06 vs 1.04 ± 0.06; P0.05), RYGB induced significantly greater increase in INR in the whole group and NASH patients than SG. After RYGB albumin decreased at 1 month (41.2 ± 2.7 vs 39.0 ± 3.2 g/L; P0.05). At 12 months, INR and albumin returned to baseline. At 12 months in NASH group, SG induced significant improvement in aspartate aminotransferase (32.4 ± 17.4 vs 21.5 ± 6.9U/L), alanine aminotransferase (39.9 ± 28.6U/L vs 23.8 ± 14.1U/L), gamma-glutamyl transpeptidase (34.3 ± 16.6 vs 24.5 ± 16.8U/L), and lactate dehydrogenase (510.8 ± 33 vs 292.4 ± 29). Variables predictive of INR change after 1 month included operation type, NAS ≥ 5, bilirubin, body mass index, hemoglobin A1C, and dyslipidemia.Patients with NASH undergoing RYGB are more susceptible to early transient deterioration of liver function than after SG.
- Published
- 2017
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