Abstract

Purpose

Bariatric surgery can improve non-alcoholic fatty liver disease (NAFLD). Yet data on the effect on fibrosis are insufficient and controversial. This work endeavored to evaluate the safety of laparoscopic sleeve gastrectomy (LSG) in cases that have compensated non-alcoholic steatohepatitis (NASH)-related cirrhosis and its impact on fibrosis stage.

Methods

The current prospective work involved 132 cases with Child-A NASH-related cirrhosis suffering from morbid obesity scheduled for LSG. They were subjected to preoperative assessment, wedge biopsy, and ultrasound-guided true-cut liver biopsy after 30 months. Patients were included if proved to have F4 fibrosis initially. The liver condition was assessed based on the NALFD Activity Score (NAS). The primary outcome measure was the impact of LSG on fibrosis stage and its relation to weight loss.

Results

The analysis included only 71 patients who completed the 30-month follow-up period. By the end of the follow-up interval, there was a substantial weight loss with a reasonable resolution of comorbidities. The median NAS decreased significantly from 6 (1–8) to 3 (0–6) after surgery. Fibrosis score regressed to F2 in 19 patients (26.8%) and F3 in 29 (40.8%). Patients with improved scores had a significantly higher amount of weight loss (p < 0.001). Improvement was more frequent in males (p = 0.007). By 30 months after treatment, 53.8% of cases with borderline NASH and 36.8% of those with probable NASH showed complete resolution, and 44.7% of patients with NASH showed improvement. Steatosis improved in 74.6% of patients (p < 0.001).

Conclusion

In patients with NASH-related liver cirrhosis of Child class A, LSG may be a secure approach for the management of morbid obesity. It has a long-term benefit for both obesity and liver condition with significant improvement of steatosis, steatohepatitis, and fibrosis.

中文翻译：

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腹腔镜袖状胃切除术对儿童 A NASH 相关肝硬化患者纤维化分期的影响

摘要

目的

减肥手术可以改善非酒精性脂肪肝（NAFLD）。然而，关于对纤维化影响的数据不充分且存在争议。这项工作试图评估腹腔镜袖状胃切除术 (LSG) 在非酒精性脂肪性肝炎 (NASH) 相关肝硬化患者中的安全性及其对纤维化阶段的影响。

方法

目前的前瞻性工作涉及 132 例与 Child-A NASH 相关的肝硬化，患有病态肥胖，计划进行 LSG。30个月后进行术前评估、楔形活检和超声引导下的真切肝活检。如果最初证明患有 F4 纤维化，则纳入患者。基于 NALFD 活动评分 (NAS) 评估肝脏状况。主要结果测量是 LSG 对纤维化阶段的影响及其与体重减轻的关系。

结果

该分析仅包括完成 30 个月随访期的 71 名患者。到随访间隔结束时，体重明显减轻，合并症得到合理解决。手术后 NAS 中位数从 6 (1-8) 显着下降至 3 (0-6)。19 名患者 (26.8%) 的纤维化评分降至 F2，29 名患者 (40.8%) 降至 F3。得分提高的患者体重减轻的量显着增加（p  < 0.001）。男性的改善更为频繁（p  = 0.007）。到治疗后 30 个月，53.8% 的临界 NASH 病例和 36.8% 的可能 NASH 病例显示完全消退，44.7% 的 NASH 患者出现改善。74.6% 的患者脂肪变性得到改善（p  < 0.001）。

结论

对于 NASH 相关的 Child A 级肝硬化患者，LSG 可能是治疗病态肥胖的安全方法。它对肥胖和肝脏状况都有长期益处，可显着改善脂肪变性、脂肪性肝炎和纤维化。