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Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: A Systematic Review and Meta-analysis.
Clin Gastroenterol Hepatol 2019; 17(6):1040-1060.e11CG

Abstract

BACKGROUND & AIMS

Bariatric surgery has been reported to lead to complete resolution of nonalcoholic fatty liver disease (NAFLD) following the sustained weight loss induced in obese patients. We performed a systematic review and meta-analysis to evaluate the effects of bariatric surgery on NAFLD in obese patients.

METHODS

We searched MEDLINE, EMBASE, CENTRAL, and Web of Science databases through May 2018 for studies that compared liver biopsy results before and after bariatric surgery in obese patients. Primary outcomes were biopsy-confirmed resolution of NAFLD and NAFLD activity score. Secondary outcomes were worsening of NAFLD after surgery and liver volume. The Grading of Recommendations, Assessment, Development, and Evidence approach was conducted to assess overall quality of evidence.

RESULTS

We analyzed data from 32 cohort studies comprising 3093 biopsy specimens. Bariatric surgery resulted in a biopsy-confirmed resolution of steatosis in 66% of patients (95% CI, 56%-75%), inflammation in 50% (95% CI, 35%-64%), ballooning degeneration in 76% (95% CI, 64%-86%), and fibrosis in 40% (95% CI, 29%-51%). Patients' mean NAFLD activity score was reduced significantly after bariatric surgery (mean difference, 2.39; 95% CI, 1.58-3.20; P < .001). However, bariatric surgery resulted in new or worsening features of NAFLD, such as fibrosis, in 12% of patients (95% CI, 5%-20%). The overall Grading of Recommendations, Assessment, Development, and Evidence quality of evidence was very low.

CONCLUSIONS

Through this systematic review and meta-analysis, we found that bariatric surgery leads to complete resolution of NAFLD in obese patients. However, some patients develop new or worsened features of NAFLD. Randomized controlled trials are needed to further examine the therapeutic benefits of bariatric surgery for patients with NAFLD.

Authors+Show Affiliations

Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.Health Sciences Library, McMaster University, Hamilton, Ontario, Canada.Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: dennishong70@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30326299

Citation

Lee, Yung, et al. "Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: a Systematic Review and Meta-analysis." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 17, no. 6, 2019, pp. 1040-1060.e11.
Lee Y, Doumouras AG, Yu J, et al. Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2019;17(6):1040-1060.e11.
Lee, Y., Doumouras, A. G., Yu, J., Brar, K., Banfield, L., Gmora, S., ... Hong, D. (2019). Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: A Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 17(6), pp. 1040-1060.e11. doi:10.1016/j.cgh.2018.10.017.
Lee Y, et al. Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: a Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2019;17(6):1040-1060.e11. PubMed PMID: 30326299.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complete Resolution of Nonalcoholic Fatty Liver Disease After Bariatric Surgery: A Systematic Review and Meta-analysis. AU - Lee,Yung, AU - Doumouras,Aristithes G, AU - Yu,James, AU - Brar,Karanbir, AU - Banfield,Laura, AU - Gmora,Scott, AU - Anvari,Mehran, AU - Hong,Dennis, Y1 - 2018/10/13/ PY - 2018/09/04/received PY - 2018/09/27/revised PY - 2018/10/01/accepted PY - 2018/10/17/pubmed PY - 2018/10/17/medline PY - 2018/10/17/entrez KW - Hepatic Histology KW - Metabolic Surgery KW - Morbid Obesity KW - NASH SP - 1040 EP - 1060.e11 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 17 IS - 6 N2 - BACKGROUND & AIMS: Bariatric surgery has been reported to lead to complete resolution of nonalcoholic fatty liver disease (NAFLD) following the sustained weight loss induced in obese patients. We performed a systematic review and meta-analysis to evaluate the effects of bariatric surgery on NAFLD in obese patients. METHODS: We searched MEDLINE, EMBASE, CENTRAL, and Web of Science databases through May 2018 for studies that compared liver biopsy results before and after bariatric surgery in obese patients. Primary outcomes were biopsy-confirmed resolution of NAFLD and NAFLD activity score. Secondary outcomes were worsening of NAFLD after surgery and liver volume. The Grading of Recommendations, Assessment, Development, and Evidence approach was conducted to assess overall quality of evidence. RESULTS: We analyzed data from 32 cohort studies comprising 3093 biopsy specimens. Bariatric surgery resulted in a biopsy-confirmed resolution of steatosis in 66% of patients (95% CI, 56%-75%), inflammation in 50% (95% CI, 35%-64%), ballooning degeneration in 76% (95% CI, 64%-86%), and fibrosis in 40% (95% CI, 29%-51%). Patients' mean NAFLD activity score was reduced significantly after bariatric surgery (mean difference, 2.39; 95% CI, 1.58-3.20; P < .001). However, bariatric surgery resulted in new or worsening features of NAFLD, such as fibrosis, in 12% of patients (95% CI, 5%-20%). The overall Grading of Recommendations, Assessment, Development, and Evidence quality of evidence was very low. CONCLUSIONS: Through this systematic review and meta-analysis, we found that bariatric surgery leads to complete resolution of NAFLD in obese patients. However, some patients develop new or worsened features of NAFLD. Randomized controlled trials are needed to further examine the therapeutic benefits of bariatric surgery for patients with NAFLD. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/30326299/Complete_Resolution_of_Nonalcoholic_Fatty_Liver_Disease_After_Bariatric_Surgery:_A_Systematic_Review_and_Meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(18)31138-8 DB - PRIME DP - Unbound Medicine ER -