Weight loss after sleeve gastrectomy significantly improves liver histopathology
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Weight loss after a laparoscopic sleeve gastrectomy correlated with significant improvements in metabolic parameters, liver enzyme levels and liver histopathology, according to study results.
“This suggests that this surgery is an attractive therapeutic approach for patients with obesity associated with NASH or other metabolic comorbidities,” Ahmed Abdallah Salman, MD, from the internal medicine department, faculty of medicine, at Cairo University in Egypt, said.
Salman and colleagues identified 81 patients with NAFLD who underwent laparoscopic sleeve gastrectomy. Before and 18 months after laparoscopic sleeve gastrectomy, investigators collected paired liver biopsies and blood specimens. To test differences between preoperative and 18 months postoperative data, researchers used paired student’s t test or Wilcoxon rank test.
“At follow up, there was a significant improvement in biochemical markers for glucose homeostasis, including fasting glucose, HbA1c, insulin levels and homeostatic model assessment index.” Salman and colleagues wrote.
Results showed an improvement in postoperative liver function tests, including serum alanine aminotransferase, aspartate aminotransferase and gammaglutamyl transpeptidase levels (P < .001 for all), compared with before weight loss measures. At baseline, there were 43 patients with definite nonalcoholic steatohepatitis, 27 patients with definite NASH and 11 patients with no NASH, while at 18 months postoperatively, there were 9 patients with definite NASH, 32 patients with borderline NASH and 40 patients with no NASH.
According the researchers, postoperative biopsies demonstrated a reduction in steatosis, liver fibrosis, lobular inflammation and hepatocyte ballooning (P < .001 for all).
“In addition, at the followup assessment, there was a significant increase in serum adiponectin levels and significant decline in serum levels of leptin, resisitin, and preB cell enhancing factor/Nampt/visfatin,” the investigators wrote.
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