Stratopoulos C et al. (2005) Changes in liver histology accompanying massive weight loss after gastroplasty for morbid obesity. Obes Surg 15: 1154–1160

Severe nonalcoholic steatohepatitis, which can result in fibrosis and cirrhosis of the liver, has recently been shown to develop in some morbidly obese patients. Obesity has been suggested to be an independent risk factor for the development of advanced fibrosis in such patients. Stratopoulos and colleagues have investigated the effect of weight loss following gastroplasty on liver histology in morbidly obese patients.

In total, 51 nondiabetic, nonalcoholic, morbidly obese patients (BMI >40) were enrolled in the study. Each underwent Mason's vertical banded gastroplasty, during which a liver biopsy was taken. Repeat biopsies were taken at a mean of 18 months postoperatively, and a third biopsy was taken in a subgroup of 16 patients, 17 months after the second. Results of the first liver biopsy revealed that in 98% of the patients, steatosis and steatohepatitis were present, and fibrosis in 94.1%. Following surgery, the overall excess weight loss within 6–35 months was 66%. The second biopsy revealed a significant regression of steatosis and steatohepatitis in 84.3% and 86.2% of patients, respectively. In addition, fibrosis and lipogranulomas decreased in severity, with an improvement in fibrosis recorded in 47% of patients. In the subgroup who underwent a third biopsy, further reductions in steatosis, steatohepatitis and fibrosis were observed. Cirrhosis was not detected at any stage in any of the patients.

The authors conclude that massive weight loss following gastroplasty in morbidly obese patients is associated with regression of nonalcoholic steatohepatitis and a significant overall decrease in fibrosis.