Roux-en-Y Gastric Bypass Versus Adjustable Gastric Banding... : Annals of Surgery (original) (raw)

Papers of the 21st Annual ESA Meeting

Roux-en-Y Gastric Bypass Versus Adjustable Gastric Banding to Reduce Nonalcoholic Fatty Liver Disease

A 5-Year Controlled Longitudinal Study

Caiazzo, Robert MD, PhD*,†; Lassailly, Guillaume MD‡,§; Leteurtre, Emmanuelle MD, PhD¶; Baud, Gregory MD*,†; Verkindt, Hélène MD*; Raverdy, Violeta MD*,†; Buob, David MD¶; Pigeyre, Marie MD, PhD†,‖; Mathurin, Philippe MD, PhD‡,§; Pattou, François MD*,†

*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.

Reprints: François Pattou, MD, Service de Chirurgie Générale et Endocrinienne, Hôpital Claude Huriez, 3ème étage Est, Ave M. Polonovski, 59037 Lille Cedex, France. E-mail: [email protected].

Disclosure: Supported by grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique) and from the Conseil Régional Nord-Pas-de-Calais (ARCIR Obésité et Alcool).

The authors declare no conflicts of interest.

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Objectives:

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/m2), 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/m2, 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.