Effects of Laparoscopic Sleeve Gastrectomy on Non-Alcoholic Steatohepatitis and Liver Fibrosis in Japanese Patients with
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ORIGINAL CONTRIBUTIONS
Effects of Laparoscopic Sleeve Gastrectomy on Non-Alcoholic Steatohepatitis and Liver Fibrosis in Japanese Patients with Severe Obesity Haruka Nikai 1 & Kazuyuki Ishida 2 & Akira Umemura 1 & Shigeaki Baba 1 & Hiroyuki Nitta 1 & Tamotsu Sugai 2 & Akira Sasaki 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The prevalence of non-alcoholic steatohepatitis (NASH) in Japanese patients with severe obesity is extremely high. The aim of the present study was to evaluate the metabolic and histological effects of laparoscopic sleeve gastrectomy (LSG) on NASH and liver fibrosis in Japanese patients with severe obesity. Methods Between June 2008 and March 2019, all 79 patients with severe obesity who underwent LSG were included in the study. Sixty-eight patients had an intraoperative liver biopsy performed at the time of LSG. Ultrasound-guided liver biopsies were performed in patients with fibrosis at 12 months after LSG. Results NASH was present in 43 patients (63.2%), and 10 patients had a unique feature in which their fibrosis were observed without steatosis at the time of LSG. Of the 28 patients with NASH, 25 showed improvement and no longer met the diagnostic criteria of NASH at 12 months after LSG. Mean pericellular fibrosis scores showed significant improvement from 1.62 at baseline, to 1.50, 1.00, and 0.78, respectively (p < 0.001). Univariate analysis of the preoperative predictors in the improvement of fibrosis showed significant effects in preoperative weight (p = 0.037), HbA1c (p = 0.037), and serum insulin (p = 0.037). Multivariate analysis revealed HbA1c to be the only preoperative predictor of improvement in fibrosis (p = 0.004; odds ratio 0.440, 95% CI 0.229–0.842). Conclusions LSG has great potential as an effective treatment for patients with NASH. Keywords Non-alcoholic steatohepatitis . Morbid obesity . Bariatric surgery . Laparoscopic sleeve gastrectomy
* Akira Sasaki [email protected] Haruka Nikai [email protected] Kazuyuki Ishida [email protected] Akira Umemura [email protected] Shigeaki Baba [email protected] Hiroyuki Nitta [email protected] Tamotsu Sugai [email protected] 1
Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Shiwa 028-3695, Japan
2
Department of Pathology, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Shiwa 028-3695, Japan
Introduction The increasing global prevalence of obesity (BMI > 30 kg/m2) presents major social and public-health burdens [1]. Although in Japan the prevalence of morbid obesity remains lower than in the USA, it is bound to increase owing to several lifestyle changes [2, 3]. Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases worldwide, and obesity represents a well-documented risk factor for NAFLD [4, 5]. The prevalence of NAFLD is the highest in patients with metabolic diseases such as type 2 diabetes mellitus (T2DM) and dyslipidemia. The spectrum of NAFLD encompasses simple non-alcoholic fatty liv
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