scholarly journals Bariatric Surgery in Cirrhotic Patients: Is It Safe?

2019 ◽  
Vol 30 (4) ◽  
pp. 1241-1248 ◽  
Author(s):  
Hafsa Younus ◽  
Amit Sharma ◽  
Rosa Miquel ◽  
Alberto Quaglia ◽  
Subba Rao Kanchustambam ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Liver Disease ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Class Iii ◽  
Alcoholic Fatty Liver ◽  
Long Term Outcome ◽  
Bariatric Patients ◽  
Cirrhotic Patients

Abstract Introduction Ten percent of cirrhotic patients are known to have a high risk of postoperative complications. Ninety percent of bariatric patients suffer from non-alcoholic fatty liver disease (NAFLD), and 50% of them may develop non-alcoholic steatohepatitis (NASH) which can progress to cirrhosis. The aim of this study was to assess whether the presence of cirrhosis at the time of bariatric surgery is associated with an increased rate and severity of short- and long-term cirrhotic complications. Methods A cohort of 110 bariatric patients, between May 2003 and February 2018, who had undergone liver biopsy at the time of bariatric surgery were reassessed for histological outcome and divided into two groups based on the presence (C, n = 26) or absence (NC, n = 84) of cirrhosis. The NC group consisted of NASH (n = 49), NAFLD (n = 24) and non-NAFLD (n = 11) liver histology. Medical notes were retrospectively assessed for patient characteristics, development of 30-day postoperative complications, severity of complications (Clavien-Dindo (CD) classification) and length of stay. The C group was further assessed for long-term cirrhosis-related outcomes. Results The C group was older (52 years vs 43 years) and had lower BMI (46 kg/m2 vs 52 kg/m2) and weight (126 kg vs 145 kg) compared to the NC group (p < 0.05). The C group had significantly higher overall complication rate (10/26 vs 14/84, p < 0.05) and severity of complications (CD class ≥ III, 12% vs 7%, p < 0.05) when compared to the NC group. The length of stay was similar between the two groups (5 days vs 4 days). The C group had significant improvement in model end-stage liver disease scores (7 vs 6, p < 0.01) with median follow-up of 4.5 years (range 2–11 years). There were no long-term cirrhosis-related complications or mortality in our studied cohort (0/26). Conclusion Bariatric surgery in cirrhotic patients has a higher risk of immediate postoperative complications. Long-term cirrhosis-related complications or mortality was not increased in this small cohort. Preoperative identification of liver cirrhosis may be useful for risk stratification, optimisation and informed consent. Bariatric surgery in well-compensated cirrhotic patients may be used as an aid to improve long-term outcome.

scholarly journals Collagen proportionate area is an independent predictor of long-term outcome in patients with non-alcoholic fatty liver disease

2019 ◽  
Vol 49 (9) ◽  
pp. 1214-1222 ◽  
Author(s):  
Elena Buzzetti ◽  
Andrew Hall ◽  
Mattias Ekstedt ◽  
Roberta Manuguerra ◽  
Marta Guerrero Misas ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Independent Predictor ◽  
Term Outcome ◽  
Alcoholic Fatty Liver ◽  
Long Term Outcome ◽  
Alcoholic Fatty Liver Disease

scholarly journals Non-Alcoholic Fatty Liver Disease (NAFLD) and Bariatric/Metabolic Surgery as Its Treatment Option: A Review

2021 ◽  
Vol 10 (24) ◽  
pp. 5721
Author(s):  
Paulina Głuszyńska ◽  
Dorota Lemancewicz ◽  
Janusz Bogdan Dzięcioł ◽  
Hady Razak Hady
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Liver Disease ◽  
Fatty Liver ◽  
Metabolic Surgery ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
Bariatric Metabolic Surgery ◽  
Alcoholic Fatty Liver Disease

The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) has considerably increased over the last years. NAFLD is currently the most common cause of chronic liver disease in the developing world. The diagnosis of NAFLD/NASH is often incidental, as the early-stage of disease is frequently free of symptoms. Most patients recognized with NAFLD have severe obesity and other obesity-related disease such as type 2 diabetes mellitus (T2DM), insulin-resistance, dyslipidemia and hypertension. The only proven method for NAFLD improvement and resolution is weight loss. Bariatric surgery leads to significant and long-term weight loss as well as improvement of coexisting diseases. There is a lot of evidence suggesting that metabolic/bariatric surgery is an effective method of NAFLD treatment that leads to reduction in steatosis, hepatic inflammation and fibrosis. However, there is still a need to perform long-term studies in order to determine the role of bariatric surgery as a treatment option for NAFLD and NASH. This review discusses current evidence about epidemiology, pathogenesis and treatment options for NAFLD including bariatric/metabolic surgery and its effect on improvement and resolution of NAFLD.

scholarly journals Mesenchymal iron deposition is associated with adverse long‐term outcome in non‐alcoholic fatty liver disease

2020 ◽  
Vol 40 (8) ◽  
pp. 1872-1882
Author(s):  
Sebastian K. Eder ◽  
Alexandra Feldman ◽  
Georg Strebinger ◽  
Jana Kemnitz ◽  
Stephan Zandanell ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Iron Deposition ◽  
Term Outcome ◽  
Alcoholic Fatty Liver ◽  
Long Term Outcome ◽  
Alcoholic Fatty Liver Disease

scholarly journals 699 Pre-Operative Screening and Investigation of Patients with Suspected Non-Alcoholic Fatty Liver Disease Among Bariatric Surgery Patients

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Antypas ◽  
A Austin ◽  
S Awad ◽  
D Hughes ◽  
I Idris
Keyword(s):  
Bariatric Surgery ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
Diagnostic Measures ◽  
Number Of Patients ◽  
Bariatric Patients ◽  
Abnormal Group ◽  
Alcoholic Fatty Liver Disease

Abstract Introduction Non-alcoholic fatty liver disease (NAFLD) is becoming more prevalent. The investigations used to diagnose NAFLD include FIB-4 score, NAFLD score and AST/ALT ratio (AAR). Gold-standard for diagnosis is liver biopsy. Bariatric surgery reduces steatosis and fibrosis in NAFLD patients. However, in undiagnosed NAFLD, it can lead to worsening fibrosis and decompensation of cirrhosis, causing complications. The aim is to identify how well bariatric patients are being screened for NAFLD pre-operatively. Method Database analysis was conducted in the bariatric clinics at Royal Derby Hospital and analysed using SPSS. Results 392 patients’ data (Overall group) were analysed and compared with those who had an AAR&gt;1 (Abnormal group). Abnormal group had a higher mean AAR, NAFLD and FIB-4 scores. Surprisingly, ALT and AST levels were higher in Overall group compared to Abnormal. Generally, patients were not pre-operatively checked sufficiently (81.9% LFTs, 62.2% ASTs). Conclusions A large number of patients could have undiagnosed NAFLD due to the lack of LFT/AST checks as ALT scores alone would miss fibrosis. Using AAR&gt;1 and FIB-4 would allow clinicians to detect fibrosis earlier to carry out non-invasive diagnostic measures, avoiding unnecessary biopsies. Early diagnosis means patients undergoing bariatric surgery with possible cirrhosis will not experience decompensation and associated complications.

scholarly journals The effect of NAFLD (non-alcoholic fatty liver disease) on long-term outcome of chronic hepatitis B in Iranian patients

2012 ◽  
Vol 02 (01) ◽  
pp. 18-21 ◽  
Author(s):  
Arezoo Estakhri ◽  
Ali Akbari Sari ◽  
Sahar Naz Nedjat ◽  
Marym Rohban ◽  
Naser Rakhshani ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Liver Disease ◽  
Hepatitis B ◽  
Fatty Liver Disease ◽  
Term Outcome ◽  
Alcoholic Fatty Liver ◽  
Long Term Outcome ◽  
Alcoholic Fatty Liver Disease ◽  
Iranian Patients

scholarly journals Bariatric Surgery and Liver Disease: General Considerations and Role of the Gut–Liver Axis

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2649
Author(s):  
Maria Cerreto ◽  
Francesco Santopaolo ◽  
Antonio Gasbarrini ◽  
Maurizio Pompili ◽  
Francesca Romana Ponziani
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Liver Disease ◽  
Short Chain Fatty Acids ◽  
Substantial Improvement ◽  
Review Literature ◽  
Supporting Evidence ◽  
Alcoholic Fatty Liver ◽  
Beneficial Effects ◽  
Cirrhotic Patients

Weight loss is a therapeutic solution for many metabolic disorders, such as obesity and its complications. Bariatric surgery aims to achieve lasting weight loss in all patients who have failed after multiple dietary attempts. Among its many benefits, it has been associated with the regression of non-alcoholic fatty liver disease (NAFLD), which is often associated with obesity, with evidence of substantial improvement in tissue inflammation and fibrosis. These benefits are mediated not only by weight loss, but also by favorable changes in systemic inflammation and in the composition of the gut microbiota. Changes in microbial metabolites such as short-chain fatty acids (SCFAs), capable of acting as endocrine mediators, and bile acids (BAs) as well as modifications of the gut-brain axis, are among the involved mechanisms. However, not all bariatric surgeries show beneficial effects on the liver; those leading to malabsorption can cause liver failure or a marked worsening of fibrosis and the development of cirrhosis. Nevertheless, there are still many unclear aspects, including the extent of the benefits and the magnitude of the risks of bariatric surgery in cirrhotic patients. In addition, the usefulness and the safety of these procedures in patients who are candidates to or who have undergone liver transplant need solid supporting evidence. This paper aims to review literature data on the use of bariatric surgery in the setting of chronic liver disease.

Sign in / Sign up

Export Citation Format

Share Document