TY - JOUR
T1 - How bariatric surgery affects liver volume and fat density in NAFLD patients
AU - Luo, Ran B.
AU - Suzuki, Toshiaki
AU - Hooker, Jonathan C.
AU - Covarrubias, Yesenia
AU - Schlein, Alexandra
AU - Liu, Shanglei
AU - Schwimmer, Jeffrey B.
AU - Reeder, Scott B.
AU - Funk, Luke M.
AU - Greenberg, Jacob A.
AU - Campos, Guilherme M.
AU - Sandler, Bryan J.
AU - Horgan, Santiago
AU - Sirlin, Claude B.
AU - Jacobsen, Garth R.
N1 - Funding Information:
National Institute of Health (NIH) Grants: R01DK088925, R01DK083380, R01DK100651, K24DK102595. Ran B. Luo and Toshiaki Suzuki are co-first authors.
Funding Information:
Disclosures Dr. Reeder reports other from Cellectar Biosciences, other from Elucent Medical, other from Calimetrix, LCC, personal fees from Parexel International, outside the submitted work. Dr. Sandler reports personal fees from W.L Gore, personal fees from Bard/Davol, personal fees from ValenTx, Inc. outside the submitted work. Dr. Horgan reports personal fees from Johnson and Johnson/ Ethicon, personal fees from W.L. Gore, personal fees from Torax/ Ethicon, personal fees from ValenTx, Inc outside the submitted work. Dr. Sirlin reports grants from National Institute of Health, during the conduct of the study; grants from Bayer, grants from Guerbet, grants from Siemens, grants from General Electric, grants from Supersonic, grants from Arterys, personal fees from Alexion, personal fees from AstraZeneca, personal fees from Bioclinica, personal fees from BMS, personal fees from Bracco, personal fees from Celgene, personal fees from Fibrogen, personal fees from Galmed, personal fees from Genentech, personal fees from Genzyme, personal fees from Gilead, personal fees from Icon, personal fees from Intercept, personal fees from Isis, personal fees from Janssen, personal fees from NuSirt, personal fees from Perspectum, personal fees from Pfizer, personal fees from Profil, personal fees from Sanofi, personal fees from Shire, personal fees from Synageva, personal fees from Tobira, personal fees from Takeda, personal fees from Virtual Scopics, outside the submitted work. Dr. Jacobsen reports personal fees from W.L.Gore, personal fees from Davol/Bard, personal fees from Viasite, personal fees from Ethicon, outside the submitted work. Drs. Luo, Suzuki, Liu, Schwimmer, Funk, Greenberg and Campos, Mr. Hooker, Ms. Schlein, and Ms. Covarrubias have no conflicts of interest or financial ties to disclose.
Publisher Copyright:
© 2017, Springer Science+Business Media, LLC.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Introduction: Nonalcoholic fatty liver disease (NAFLD) is an epidemic in the obese population. Bariatric surgery is known to reverse multiple metabolic complications of obesity such as diabetes, dyslipidemia, and NAFLD, but the timing of liver changes has not been well described. Materials and Methods: This was an IRB-approved, two-institutional prospective study. Bariatric patients received MRIs at baseline and after a pre-operative liquid diet. Liver biopsies were performed during surgery and if NAFLD positive, the patients received MRIs at 1, 3, and 6 months. Liver volumes and proton-density fat fraction (PDFF) were calculated from offline MRI images. Primary outcomes were changes in weight, body mass index (BMI), percent excess weight loss (EWL%), liver volume, and PDFF. Resolution of steatosis, as defined as PDFF OpenSPiltSPi 6.4% based on previously published cutoffs, was assessed. Secondarily, outcomes were compared between patients who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Results: From October 2010 to June 2015, 124 patients were recruited. 49 patients (39.5%) completed all five scans. EWL% at 6 months was 55.6 ± 19.0%. BMI decreased from 45.3 ± 5.9 to 34.4 ± 5.1 kg/m2 and mean liver volume decreased from 2464.6 ± 619.4 to 1874.3 ± 387.8 cm3 with a volume change of 21.4 ± 11.4%. PDFF decreased from 16.6 ± 7.8 to 4.4 ± 3.4%. At 6 months, 83.7% patients had resolution of steatosis. Liver volume plateaued at 1 month, but PDFF and BMI continued to decrease. There were no statistically significant differences in liver volume or PDFF reduction from baseline to 6 months between the LSG versus LRYGB subgroups. Conclusion: Patients with NAFLD undergoing bariatric surgery can expect significant decreases in liver volume and hepatic steatosis at 6 months, with 83.7% of patients achieving resolution of steatosis. Liver volume reduction plateaus 1-month post-bariatric surgery, but PDFF continues to decrease. LSG and LRYGB did not differ in efficacy for inducing regression of hepatosteatosis.
AB - Introduction: Nonalcoholic fatty liver disease (NAFLD) is an epidemic in the obese population. Bariatric surgery is known to reverse multiple metabolic complications of obesity such as diabetes, dyslipidemia, and NAFLD, but the timing of liver changes has not been well described. Materials and Methods: This was an IRB-approved, two-institutional prospective study. Bariatric patients received MRIs at baseline and after a pre-operative liquid diet. Liver biopsies were performed during surgery and if NAFLD positive, the patients received MRIs at 1, 3, and 6 months. Liver volumes and proton-density fat fraction (PDFF) were calculated from offline MRI images. Primary outcomes were changes in weight, body mass index (BMI), percent excess weight loss (EWL%), liver volume, and PDFF. Resolution of steatosis, as defined as PDFF OpenSPiltSPi 6.4% based on previously published cutoffs, was assessed. Secondarily, outcomes were compared between patients who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Results: From October 2010 to June 2015, 124 patients were recruited. 49 patients (39.5%) completed all five scans. EWL% at 6 months was 55.6 ± 19.0%. BMI decreased from 45.3 ± 5.9 to 34.4 ± 5.1 kg/m2 and mean liver volume decreased from 2464.6 ± 619.4 to 1874.3 ± 387.8 cm3 with a volume change of 21.4 ± 11.4%. PDFF decreased from 16.6 ± 7.8 to 4.4 ± 3.4%. At 6 months, 83.7% patients had resolution of steatosis. Liver volume plateaued at 1 month, but PDFF and BMI continued to decrease. There were no statistically significant differences in liver volume or PDFF reduction from baseline to 6 months between the LSG versus LRYGB subgroups. Conclusion: Patients with NAFLD undergoing bariatric surgery can expect significant decreases in liver volume and hepatic steatosis at 6 months, with 83.7% of patients achieving resolution of steatosis. Liver volume reduction plateaus 1-month post-bariatric surgery, but PDFF continues to decrease. LSG and LRYGB did not differ in efficacy for inducing regression of hepatosteatosis.
KW - Bariatric surgery
KW - Gastric bypass
KW - Liver volume
KW - NAFLD
KW - Sleeve gastrectomy
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U2 - 10.1007/s00464-017-5846-9
DO - 10.1007/s00464-017-5846-9
M3 - Article
C2 - 29218660
AN - SCOPUS:85037333560
SN - 0930-2794
VL - 32
SP - 1675
EP - 1682
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 4
ER -
