비만 수술 후 비알코올성 지방간의 완전한 소실, Complete Resolution of NAFLD After Bariatric Surgery

Complete resolutin of NAFLD after bariatric surgery.pdf

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BACKGROUND & AIMS:

Bariatric surgery has been reported to lead to complete resolution of nonalcoholic fatty liver

disease (NAFLD) following the sustained weight loss induced in obese patients. We performed a

systematic review and meta-analysis to evaluate the effects of bariatric surgery on NAFLD in

obese patients.

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METHODS:

We searched MEDLINE, EMBASE, CENTRAL, and Web of Science databases through May 2018 for

studies that compared liver biopsy results before and after bariatric surgery in obese patients.

Primary outcomes were biopsy-confirmed resolution of NAFLD and NAFLD activity score. Secondary

outcomes were worsening of NAFLD after surgery and liver volume. The Grading of

Recommendations, Assessment, Development, and Evidence approach was conducted to assess

overall quality of evidence.

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RESULTS:

We analyzed data from 32 cohort studies comprising 3093 biopsy specimens. Bariatric surgery

resulted in a biopsy-confirmed resolution of steatosis in 66% of patients (95% CI, 56%–75%),

inflammation in 50% (95% CI, 35%–64%), ballooning degeneration in 76% (95% CI, 64%–

86%), and fibrosis in 40% (95% CI, 29%–51%). Patients’ mean NAFLD activity score was

reduced significantly after bariatric surgery (mean difference, 2.39; 95% CI, 1.58–3.20; P <

.001). However, bariatric surgery resulted in new or worsening features of NAFLD, such as

fibrosis, in 12% of patients (95% CI, 5%–20%). The overall Grading of Recommendations,

Assessment, Development, and Evidence quality of evidence was very low.

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CONCLUSIONS:

Through this systematic review and meta-analysis, we found that bariatric surgery leads to

complete resolution of NAFLD in obese patients. However, some patients develop new or

worsened features of NAFLD. Randomized controlled trials are needed to further examine the

therapeutic benefits of bariatric surgery for patients with NAFLD.

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