Sleeve gastrectomy versus Roux-en-Y gastric bypass for nonalcoholic fatty liver disease: a systematic review and meta-analysis.
Chenming Liu, Rui Lu, Wenyuan Tang et al.
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In 30 seconds
This systematic review and meta-analysis compared sleeve gastrectomy (SG) with Roux-en-Y gastric bypass (RYGB) for nonalcoholic fatty liver disease. It included 16 original studies and assessed liver histology, enzymes, and weight outcomes. The primary analysis found no significant overall difference between procedures in improvement in NAFLD activity score (MD = .23, 95% CI: .69-1.16). RYGB was associated with greater weight loss. Exploratory subgroup results suggested differing long-term patterns across liver outcomes, while metaregression linked between-procedure differences in weight loss with NAS effect size; these analyses were considered hypothesis-generating.
Key findings
- Overall NAS improvement did not differ significantly between SG and RYGB (MD = .23, 95% CI: .69-1.16).
- RYGB was associated with greater weight loss than SG.
- At follow-up beyond 1 year, the NAS point estimate favored RYGB (MD = .75, 95% CI: .03-1.47), while ALT reduction favored SG (MD = -5.92, 95% CI: -8.24 to 3.60).
- Metaregression associated weight-loss differences with NAS effect size (β = -.11, 95% CI: -.21 to .01, P = .032; R 2 = 100%).
Why it matters
The findings suggest that greater weight loss after RYGB does not establish an overall histological advantage over SG, and that apparent differences may be related to weight-loss efficacy. Liver outcomes also varied across exploratory long-term analyses. Distinguishing procedure effects from weight-loss effects is relevant when interpreting evidence on bariatric surgery and NAFLD.
What to keep in mind
The long-term subgroup analyses were exploratory and hypothesis-generating; the authors state that the findings require confirmation in future prospective studies.