Hepatic outcomes after jejunoileal bypass: is there a publication bias?
BACKGROUND
One of the reasons why jejunoileal bypass (JIB) was abandoned were reports of liver failure. The aim of this study was to describe histological findings in the intraoperative and follow-up liver biopsies of a cohort of super-obese patients who had undergone JIB.


METHODS
50 consecutive patients underwent JIB. Samples of liver biopsies performed intraoperatively (41 patients) and in the follow-up (31 patients) were evaluated. Brunt's scale was used.


RESULTS
Mean age at operation was 37.9 +/- 7.6 years, and 15 patients (30.6%) had diabetes type 2, 20 (40.8%) had dyslipidemia, 29 (59.2%) had high blood pressure, and one (0.5%) had hepatitis C. Mean BMI preoperatively was 52.8 +/- 7.5 kg/m(2). Mean follow-up time was 67.0 +/- 42.8 months. At the time of the latest liver biopsy, the mean BMI was 35.7 +/- 7.5 kg/m(2). The % excess weight loss (%EWL) was 62.4 +/- 20.0%. 8 deaths (16%) have occurred, none from liver-related complications. At liver biopsy during the JIB operation, NAFLD was confirmed in 36 patients (86.7%) and NASH in 13 (31.7%). In 25 patients with mean follow-up of 4.8 +/- 4.0 years, there was no statistically significant change in the liver histology regarding the extent of steatosis (P=0.20), steatohepatitis (P=0.74) and fibrosis (P=0.71).


CONCLUSIONS
There was a significant metabolic improvement, maintenance of the %EWL, and no worsening of liver histology. There has possibly been a publication bias concerning liver outcomes, where the type of JIB and the concomitance of hepatitis C were not taken into account.
Meinhardt
Nelson Guardiola
NG
Class III Obesity Care Center, Porto Alegre, Brazil. nelsonmeinhardt@gmail.com
Souto
Kátia Elisabete Pires
KE
Ulbrich-Kulczynski
Jane Maria
JM
Stein
Airton Teitelbom
AT
D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D006801:Humans; D007581:Jejunoileal Bypass; D008099:Liver / Q000473:pathology*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss