Inka Miñambres1,2, Miguel Angel Rubio3, Ana de Hollanda4, Irene Breton5, Nuria Vilarrasa6,7, Silvia Pellitero7,8, Marta Bueno9, Albert Lecube7,9, Clara Marcuello3, Albert Goday10,11,12, Maria D Ballesteros13, German Soriano10,14,15, Assumpta Caixàs16. 1. Endocrinology and Nutrition Department, Hospital de La Santa Creu i Sant Pau, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain. iminambres@santpau.cat. 2. Medicine Department, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain. iminambres@santpau.cat. 3. Endocrinology and Nutrition Department. Hospital Clínico San Carlos. IDISSC. Facultad de Medicina, Universidad Complutense, C/ Martín Lagos s/n, 28040, Madrid, Spain. 4. Obesity Unit, Hospital Clínic Universitari, Barcelona Spain. C/Villarroel 170, 08036, Barcelona, Spain. amdehol@clinic.cat. 5. Endocrinology and Nutrition Department, Hospital General Universitario Gregorio Marañón, IISGM. C/ Pez Austral 12, 4 °C, 28007, Madrid, Spain. 6. Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. 7. CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain. 8. Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital-IGTP, ctra Canyet s/n Badalona, 08916, Barcelona, Spain. 9. Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova. Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Av. Rovira Roure 80, 25198, Lleida, Catalonia, Spain. 10. Medicine Department, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain. 11. Endocrinology and Nutrition Department, Hospital del Mar, Paseo Maritimo 25-29, 08003, Barcelona, Spain. 12. Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, Madrid, Spain. 13. Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, Edificio Administrativo Ala Sur, 1ª planta Altos de Nava s /n, 24008, Leon, Spain. 14. Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain. 15. CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. 16. Department of Endocrinology and Nutrition, Parc Taulí University Hospital, UAB, Sabadell, Spain.
Abstract
CONTEXT: Information concerning the risk-benefit profile of bariatric surgery in subjects with liver cirrhosis is scarce. Our aim was to describe the long-term outcomes of bariatric surgery in a cohort of patients with liver cirrhosis submitted to bariatric surgery. METHODS: This was a multicenter, retrospective observational study performed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), with a review of patients with cirrhosis who had undergone bariatric surgery during the period from April 2004 to March 2017 in ten public reference hospitals in Spain. RESULTS: Data on 41 patients with cirrhosis submitted to obesity surgery were collected (mean age 53.8 ± 7.9 years, 46.3% women, presurgical BMI 45 ± 8.3 kg/m2). All but one patient belonged to Child-Pugh class A, and sleeve gastrectomy was conducted in 68.3% of cases. Percentage of total weight loss (%TWL) was 26.33 ± 8.3% and 21.16 ± 15.32% at 1 and 5 years after surgery, respectively. This was accompanied by a significant reduction of type 2 diabetes, high blood pressure, and dyslipidemia and by an improvement of liver enzymes over time. Model for End-Stage Liver Disease (MELD) index increased from 7.2 ± 1.9 to 9.8 ± 4.6 after 5 years. Seven patients (17%) developed early postsurgical complications. No postsurgical mortality was observed. During follow-up, only five patients developed liver decompensation. CONCLUSIONS: Bariatric surgery in selected patients with liver cirrhosis has metabolic benefits that could have a positive impact on liver prognosis. TRIAL REGISTRATION: Controlledtrials.com Identifier: 10.1186/ISRCTN15009106.
CONTEXT: Information concerning the risk-benefit profile of bariatric surgery in subjects with liver cirrhosis is scarce. Our aim was to describe the long-term outcomes of bariatric surgery in a cohort of patients with liver cirrhosis submitted to bariatric surgery. METHODS: This was a multicenter, retrospective observational study performed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), with a review of patients with cirrhosis who had undergone bariatric surgery during the period from April 2004 to March 2017 in ten public reference hospitals in Spain. RESULTS: Data on 41 patients with cirrhosis submitted to obesity surgery were collected (mean age 53.8 ± 7.9 years, 46.3% women, presurgical BMI 45 ± 8.3 kg/m2). All but one patient belonged to Child-Pugh class A, and sleeve gastrectomy was conducted in 68.3% of cases. Percentage of total weight loss (%TWL) was 26.33 ± 8.3% and 21.16 ± 15.32% at 1 and 5 years after surgery, respectively. This was accompanied by a significant reduction of type 2 diabetes, high blood pressure, and dyslipidemia and by an improvement of liver enzymes over time. Model for End-Stage Liver Disease (MELD) index increased from 7.2 ± 1.9 to 9.8 ± 4.6 after 5 years. Seven patients (17%) developed early postsurgical complications. No postsurgical mortality was observed. During follow-up, only five patients developed liver decompensation. CONCLUSIONS: Bariatric surgery in selected patients with liver cirrhosis has metabolic benefits that could have a positive impact on liver prognosis. TRIAL REGISTRATION: Controlledtrials.com Identifier: 10.1186/ISRCTN15009106.
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Authors: Albert Lecube; Ana de Hollanda; Alfonso Calañas; Núria Vilarrasa; Miguel Angel Rubio; Irene Breton; Albert Goday; Josep Vidal; Paloma Iglesias; María Luisa Fernández-Soto; Silvia Pellitero; Ana Isabel de Cos; María José Morales; Cristina Campos; Lluís Masmiquel; Francisco Tinahones; Pedro Pujante; Pedro P García-Luna; Marta Bueno; Rosa Cámara; Orosia Bandrés; Assumpta Caixàs Journal: Obes Surg Date: 2016-08 Impact factor: 4.129