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

Melania Manco; Antonella Mosca; Francesco De Peppo; Romina Caccamo; Renato Cutrera; Ugo Giordano; Cristiano De Stefanis; Anna Alisi; Ulrich Baumann; Gianfranco Silecchia; Valerio Nobili

doi:10.1016/j.jpeds.2016.08.101

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

J Pediatr. 2017 Jan:180:31-37.e2. doi: 10.1016/j.jpeds.2016.08.101. Epub 2016 Sep 30.

Authors

Affiliations

¹ Research Unit for Multifactorial Disease, Bambino Gesù Children's Hospital, Rome, Italy.
² Hepatometabolic Unit, Bambino Gesù Children's Hospital, Rome, Italy.
³ Pediatric General Surgery Unit, Bambino Gesù Children's Hospital, Palidoro (Roma), Italy.
⁴ Respiratory Unit, Bambino Gesù Children's Hospital, Rome, Italy.
⁵ Sport Medicine Unit, Bambino Gesù Children's Hospital, Rome, Italy.
⁶ Liver Research Unit, Bambino Gesù Children's Hospital, Rome, Italy.
⁷ Pediatric Gastroenterology and Hepatology, Children's Hospital, Hannover Medical School, Hannover, Germany.
⁸ Department of Medical Surgical Sciences and Biotechnologies Faculty of Pharmacy and Medicine - Polo Pontino, Bariatric Center of Excellence IFSO-EU, Sapienza University, Rome, Italy.
⁹ Hepatometabolic Unit, Bambino Gesù Children's Hospital, Rome, Italy; Liver Research Unit, Bambino Gesù Children's Hospital, Rome, Italy. Electronic address: nobili66@yahoo.it.

PMID: 27697327
DOI: 10.1016/j.jpeds.2016.08.101

Abstract

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.

Keywords: NAFLD; adolescents; bariatric surgery; obesity.

Publication types

Comparative Study

MeSH terms

Adolescent
Bariatric Surgery*
Female
Gastrectomy / methods*
Humans
Laparoscopy*
Life Style
Liver Cirrhosis / etiology*
Male
Non-alcoholic Fatty Liver Disease / etiology*
Pediatric Obesity / complications*
Pediatric Obesity / surgery*
Pediatric Obesity / therapy
Prospective Studies
Treatment Outcome