Systematic review and meta-analysis of Roux-en-Y gastric bypass against laparoscopic sleeve gastrectomy for amelioration of NAFLD using four criteria

• Published in: Surgery for obesity and related diseases Vol. 15; no. 12; pp. 2123 - 2130
• Main Authors: Baldwin, Dustin, Chennakesavalu, Mohansrinivas, Gangemi, Antonio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2019
• Subjects: LSG; Meta-analysis; NAFLD; NAS; NFS; RYGB; LSG; NAS; NAFLD; NFS; RYGB; Meta-analysis
• ISSN: 1550-7289; 1878-7533; 1878-7533
• DOI: 10.1016/j.soard.2019.09.060

Nonalcoholic fatty liver disease (NAFLD) prevalence is rising worldwide, as a direct consequence of the obesity epidemic. Bariatric surgery provides proven NAFLD amelioration, although questions remain regarding whether Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG) is more effective. To answer this question, we conducted a systematic review and meta-analysis exclusively comparing RYGB and LSG for amelioration of NAFLD using 4 separate criteria: alanine transaminase, aspartate transaminase, NAFLD activity score, and NAFLD fibrosis score. Our search included 1290 initial studies, which were narrowed to 20 final studies in the meta-analysis. Overall, both RYGB and LSG significantly improved alanine transaminase, aspartate transaminase, NAFLD activity score, and NAFLD fibrosis score postoperatively. Direct comparisons of RYGB to LSG in any of the 4 criteria failed to demonstrate superiority. Our findings corroborate the current literature showing that bariatric surgery significantly improves biochemical and histologic parameters in patients with NAFLD. The novel individual comparisons of 4 criteria failed to show superiority between RYGB and LSG in ameliorating NAFLD. Despite several limitations, our study can assist clinicians by supporting the notion that RYGB and LSG may be equally efficacious in ameliorating NAFLD. •Systematic Review and Meta-analysis comparing amelioration of NAFLD between LSG and RYGB.•Direct comparison of RYGB and LSG using four separate criteria: ALT, AST, NAFLD Activity Score (NAS), and NAFLD Fibrosis Score (NFS).•The novel individual comparisons of four criteria failed to show superiority between RYGB and LSG in ameliorating NAFLD.•Our study can assist clinicians by supporting the notion that either RYGB or LSG may be equally efficacious in ameliorating NAFLD.