101 - Freie Mitteilung
Bariatry & hernia II
17. Mai 2019, 14:15 - 15:45, Bellavista 5, 6. OG
Early outcome in patients with non-alcoholic fatty liver in comparison with patients with non-alcoholic steatohepatitis undergoing gastric bypass- a propensity score matched analysis
Z. Abbassi, S. D. Sgardello, S. P. Naïken, N. Niclauss, M. Chevallay, S. P. Mönig, C. Toso, M. E. Hagen, M. K. Jung, Presenter: Z. Abbassi (Geneva)
Incidence of non-alcoholic steatohepatitis (NASH) in the obese population is reported up to 10-20% and postoperative weight loss as well as metabolic outcome after Roux-en-Y gastric bypass (RYGB) may be impaired in these patients. In the present study we compare postoperative glycemic control, liver function and weight loss in two groups of patients with non-alcoholic fatty liver (NAFL) and NASH who underwent RYGB.
We retrospectively evaluated 517 patients undergoing RYGB with concomitant liver biopsy between 1997 and 2013. Clinical follow up was performed at 12 months after surgery. Furthermore, we performed a propensity score matching (PSM) 1:1 on age, sex, BMI and incidence of diabetes.
Within the entire cohort, at baseline before matching, the NAFL (n=422) and NASH (n=95) groups were comparable in age, body mass index (BMI), ASA score and sex ratio whereas the incidence of diabetes differed significantly (23% vs 47%;p<0,001). At baseline the NAFL group had significantly lower glycemia (6,3±2 vs 7,9±3,5;p<0,001), insulinemia (24,1±15,2 vs 41,8±45,1; p<0,001), aspartate aminotransferase (ASAT) (21,8 ± 11,8 vs 38 ± 28,9;p<0,001) and alanine aminotransferase (ALAT) (31,8±25,1 vs 61,1±46,8;p<0,001). The homeostasis model assessment insulin resistance (HOMA-IR) was significantly lower in the NAFL group (6,2±5,7 vs 11,9 ± 13,9;p<0,001). At the one year follow up of the entire cohort, the two groups were comparable in BMI, percentage excess weight loss (EWL) (70,79±21% vs 78,16±20%), ASAT, ALAT. Glycemia (4,8±1 vs 5,2±1,4;p=0.045), insulinemia (24,1±15,2 vs 41,8 ± 45,1;p=0,001) and HOMA-IR (2,3±1 vs 1,6±1,15;p=0,001) were significantly higher in the NASH group. At Baseline, the PSM analysis of 56 patients in each group and showed us a significantly lower ASAT (23.5±15.4 vs 33.35±21.5;p=0.007), ALAT (34.3±22.7 vs 55.2±35.8; p<0.001) in the NAFL group. But after 1 year, the PSM demonstrated similar EWL, liver enzymes, glycemia and HOMA-IR, whereas the insulinemia (7.9±4.2 vs 10.2±4.3;p=0.04) differed significantly between the groups.
Patients with NASH seem to improve their liver function after gastric bypass and show comparable weight loss in comparison with patients with NAFL. Meanwhile, glycemic control seems to be compromised in patients with NASH after gastric bypass in comparison with NAFL even in well-matched obese patients.