Abstract
SINGLE ANASTOMOSIS DOUDENO-ILEAL BYPASS WITH SLEEVE GASTRECTOMY ALLEVIATES LIVER STIFFNESS AND CONTROLLED ATTENUATION PARAMETER IN OBESE PATIENTS – COMPARISON OF 4 MODALITIES
Background:
Obesity, metabolic syndrome, and non-alcoholic fatty liver disease (NAFLD) are becoming increasingly prevalent. Bariatric surgery, combining weight loss with metabolic improvements, may represent an effective treatment for these disease entities in obese patients with single anastomosis doudeno-ileal bypass with sleeve gastrectomy (SADI-S) representing a novel bariatric procedure. According to the recent guidance on non-invasive tests, liver stiffness measurement (LSM) assessed by vibration-controlled transient elastography (VCTE) or shear wave elastography (SWE) is recommended for risk stratification.
Methods:
Patients who underwent bariatric surgery at the Vienna General Hospital between 01/2021-12/2022 were included in this prospective study. LSM (via VCTE, as well as point SWE [pSWE] and 2D-SWE using the Siemens Sequoia Acuson system) and controlled attenuation parameter (CAP) assessment were performed before (baseline; BL) and three months after surgery (3M). Patients were stratified for the type of bariatric surgery.
Results:
Overall, 93 patients (SADI-S: 30.1% [n=28], one anastomosis gastric bypass [OAGB]: 28.0% [n=26]; Roux-en-Y gastric bypass [RYGB]: 29.0% [n=27]; sleeve gastrectomy [SG]: 12.9% [n=12]) with female predominance (68.8%) and a median age of 40.9 years were included. Patients with SADI-S had the highest median body mass index (BMI; 53.3 kg/m2). The median excess weight loss (EWL) after 3 months among all patients was 46.8% and did not differ between the different bariatric procedures.
VCTE and CAP paired success rates were 76.8% (n=43/56) and 83.9% (n=47/56), while it was 98.2% (n=55/56) for pSWE and 2D-SWE, respectively. After SADI-S and RYGB, VCTE significantly decreased (SADI-S: BL: 7.3 kPa vs. 3M: 4.8 kPa; p<0.001/RYGB: BL: 5.5 kPa vs. 3M: 4.1 kPa; p=0.028), while it remained unchanged after OAGB (p=0.391) and SG (p=0.999). Moreover, pSWE and 2D SWE LSM dropped significantly after SADI-S (pSWE: BL: 3.9 kPa vs. 3M: 2.7 kPa; p=0.002/2D SWE: BL: 4.9 kPa vs. 3M: 3.2 kPa; p<0.001), but not after other bariatric procedures. Interestingly, 19 patients (44.2%) showed no relevant decrease in LSM after bariatric surgery (<10% decrease).
Finally, there was a marked decline in CAP after SADI-S (BL: 367.5 dB/m vs. 3M: 286.0 dB/m; p=0.020), OAGB (BL: 303.0 dB/m vs. 3M: 4.1 dB/m; p=0.019) and RYGB (BL: 343.0 kPa vs. 3M: 277.0 dB/m; p<0.001).
Conclusion:
LSM - as assessed by both VCTE and SWE - significantly decreased 3 months after bariatric surgery, particularly in patients undergoing SADI-S. We will continue to evaluate if the decrease in LSM and CAP are ‘just’ due to EWL or will translate into improved clinical outcomes.