The Benefit of Sleeve Gastrectomy in Obese Adolescents on Nonalcoholic Steatohepatitis and Hepatic Fibrosis

• Published in: The Journal of pediatrics 2017-01, Vol.180, p.31-37.e2
• Main Authors: Manco, Melania, MD, PhD, FACN, Mosca, Antonella, MD, De Peppo, Francesco, MD, Caccamo, Romina, MD, Cutrera, Renato, MD, Giordano, Ugo, MD, De Stefanis, Cristiano, PhD, Alisi, Anna, PhD, Baumann, Ulrich, MD, Silecchia, Gianfranco, MD, PhD, Nobili, Valerio, MD
• Format: Article
• Language: English
• Subjects: Adolescent; adolescents; Bariatric Surgery; Female; Gastrectomy - methods; Humans; Laparoscopy; Life Style; Liver Cirrhosis - etiology; Male; NAFLD; Non-alcoholic Fatty Liver Disease - etiology; obesity; Pediatric Obesity - complications; Pediatric Obesity - surgery; Pediatric Obesity - therapy; Pediatrics; Prospective Studies; Treatment Outcome
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.08.101

Objective To determine whether bariatric surgery is effective for the treatment of nonalcoholic steatohepatitis (NASH) in adolescence, we compared the efficacy of laparoscopic sleeve gastrectomy (LSG) with that of lifestyle intervention (nonsurgical weight loss [NSWL]) for NASH reversal in obese adolescents. Study design Obese (body mass index ≥ 35 kg/m2 ) adolescents (13-17 years of age) with biopsy-proven NAFLD underwent LSG, lifestyle intervention plus intragastric weight loss devices (IGWLD), or only NSWL. At baseline and 1 year after treatment, patients underwent clinical and psychosocial evaluation, blood tests, liver biopsy, polysomnography, and 24-hour ambulatory blood pressure estimation. Results Twenty patients (21%) underwent LSG, 20 (21%) underwent IGWLD, and 53 (58%) received lifestyle intervention alone (NSWL). One year after treatment, patients who underwent LSG lost 21.5% of their baseline body weight, whereas patients who underwent IGWLD lost 3.4%, and patients who underwent NSWL increase 1.7%. In patients who underwent LSG, NASH reverted completely in all patients and hepatic fibrosis stage 2 disappeared in 18 patients (90%). After IGWLD, NASH reverted in 6 patients (24%) and fibrosis in 7 (37%). Patients who received the NSWL intervention did not improve significantly. Hypertension resolved in all patients who underwent LSG with preoperative hypertension (12/12) versus 50% (4/8) of the patients who underwent IGWLD ( P  = .02). The cohort-specific changes in impaired glucose metabolism were similar: 100% (9/9) of affected patients who underwent LSG versus 50% (1/2) of patients who underwent IGWLD ( P  = .02). LSG was also more affective in resolving dyslipidemia (55% [7/12] vs 26% [10/19]; P  = .05) and sleep apnea (78% [2/9] vs 30% [11/20]; P  = .001). Conclusion LSG was more effective than lifestyle intervention, even when combined with intragastric devices, for reducing NASH and liver fibrosis in obese adolescents after 1 year of treatment.