Roux-en-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study.
OBJECTIVE
To compare the long-term benefit of gastric bypass [Roux-en-Y gastric bypass (RYGB)] versus adjustable gastric banding (AGB) on nonalcoholic fatty liver disease (NAFLD) in severely obese patients.


BACKGROUND
NAFLD improves after weight loss surgery, but no histological study has compared the effects of the various bariatric interventions.


METHODS
Participants consisted of 1236 obese patients (body mass index=48.4±7.6 kg/m), enrolled in a prospective longitudinal study for up to 5 years after RYGB (n=681) or AGB (n=555). Liver biopsy samples were available for 1201 patients (97.2% of those at risk) at baseline, 578 patients (47.2%) at 1 year, and 413 patients (68.9%) at 5 years.


RESULTS
At baseline, NAFLD was present in 86% patients and categorized as severe [NAFLD activity score (NAS)≥3] in 22% patients. RYGB patients had a higher body mass index (49.8±8.2 vs 46.8±6.5 kg/m, P<0.001) and more severe NAFLD (NAS: 2.0±1.5 vs 1.7±1.4, P=0.004) than AGB patients. Weight loss at 5 years was 25.5%±11.8% after RYGB versus 21.4%±12.7% after AGB (P<0.001). When analyzed with a mixed model, all NAFLD parameters improved after surgery (P<0.001) and improved significantly more after RYGB than after AGB [steatosis (%): 1 year, 7.9±13.7 vs 17.9±21.5, P<0.001/5 years, 8.7±7.1 vs 14.5±20.8, P<0.05; NAS: 1 year, 0.7±1.0 vs 1.1±1.2, P<0.001/5 years, 0.7±1.2 vs 1.0±1.3, P<0.05]. In multivariate analysis, the superiority of RYGB was primarily but not entirely explained by weight loss.


CONCLUSIONS
The improvement of NAFLD was superior after RYGB than after AGB.
*General and Endocrine Surgery, Lille University Hospital, Lille, France †Inserm U 859, European Genomic Institute for Diabetes, Lille University, Lille, France ‡Hepathology, Lille University Hospital, Lille, France §Inserm U 995, Lille, France ¶Pathology, Lille University Hospital, Inserm U 837, Lille, France ‖Nutrition, Lille University Hospital, Lille, France.
Robert
R
Caiazzo
Guillaume
G
Lassailly
Emmanuelle
E
Leteurtre
Gregory
G
Baud
Hélène
H
Verkindt
Violeta
V
Raverdy
David
D
Buob
Marie
M
Pigeyre
Philippe
P
Mathurin
François
F
Pattou
D001706:Biopsy; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000209:etiology / Q000601:surgery*; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome