Outcomes of Patients with Severe Obesity and Cirrhosis with Portal Hypertension Undergoing Bariatric Surgery: a Systematic Review.
Bariatric surgery
Cirrhosis
NAFLD
Non-alcoholic fatty liver disease
Obesity
Portal hypertension
Journal
Obesity surgery
ISSN: 1708-0428
Titre abrégé: Obes Surg
Pays: United States
ID NLM: 9106714
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
27
09
2022
accepted:
18
11
2022
revised:
02
11
2022
pubmed:
25
11
2022
medline:
14
1
2023
entrez:
24
11
2022
Statut:
ppublish
Résumé
Thus far, little attention has been paid to bariatric surgery (BS) in patients with severe obesity (SO) and cirrhosis with portal hypertension (PH). To address this knowledge gap, we systematically reviewed the available literature and evidence about BS in patients with SO and cirrhosis with PH. We inform on the perioperative and long-term outcomes of this intervention. Articles were identified in MEDLINE, SCOPUS, LILACS, and SCIELO, and included if they analyzed SO patients with clinically significant PH and reported the characteristics and outcomes of BS. Six articles, including 32 patients, were included. The most frequent type of BS was sleeve gastrectomy performed in 27 patients. Perioperative transfusions were often not required, with only one case report describing the use of 1 unit of packed red blood cells post-operatively. Neither intraoperative nor post-op deaths were reported. All patients reported significant weight loss with improvements in comorbidities during the follow-up periods. Overall, 27 out of 29 patients had T2DM resolution, and 13 out of 23 had arterial hypertension resolution. One study reported improvements in the parameters of fibroscan. This systematic review described the outcomes of BS among patients with SO with cirrhosis and PH. Performing this kind of surgery among these patients appears safe and associated with acceptable perioperative and long-term outcomes. However, further studies are required to provide evidence-based, strong recommendations.
Identifiants
pubmed: 36422758
doi: 10.1007/s11695-022-06362-9
pii: 10.1007/s11695-022-06362-9
doi:
Types de publication
Systematic Review
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
224-233Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15:288–98.
doi: 10.1038/s41574-019-0176-8
Lonardo A, Mantovani A, Lugari S, Targher G. Epidemiology and pathophysiology of the association between NAFLD and metabolically healthy or metabolically unhealthy obesity. Ann Hepatol Mexico. 2020;19:359–66.
doi: 10.1016/j.aohep.2020.03.001
Younossi ZM, Golabi P, de Avila L, Paik JM, Srishord M, Fukui N, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: a systematic review and meta-analysis. J Hepatol Netherlands. 2019;71:793–801.
doi: 10.1016/j.jhep.2019.06.021
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology United States. 2016;64:73–84.
doi: 10.1002/hep.28431
Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic steatohepatitis: a review. JAMA. 2020;323:1175–83.
doi: 10.1001/jama.2020.2298
Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis Lancet (London, England). England. 2021;398:1359–76.
Patton H, Heimbach J, McCullough A. AGA clinical practice update on bariatric surgery in cirrhosis: expert review. Clin Gastroenterol Hepatol Elsevier. 2021;19:436–45.
doi: 10.1016/j.cgh.2020.10.034
Tetangco EP, Silva RG, Lerma EV. Portal hypertension: etiology, evaluation, and management. Dis Mon United States. 2016;62:411–26.
doi: 10.1016/j.disamonth.2016.08.001
Francque S, Verrijken A, Mertens I, Hubens G, Van Marck E, Pelckmans P, et al. Noncirrhotic human nonalcoholic fatty liver disease induces portal hypertension in relation to the histological degree of steatosis. Eur J Gastroenterol Hepatol England. 2010;22:1449–57.
Pasarín M, La Mura V, Gracia-Sancho J, García-Calderó H, Rodríguez-Vilarrupla A, García-Pagán JC, et al. Sinusoidal endothelial dysfunction precedes inflammation and fibrosis in a model of NAFLD. PLoS ONE. 2012;7:e32785.
doi: 10.1371/journal.pone.0032785
Ferrusquía-Acosta J, Bassegoda O, Turco L, Reverter E, Pellone M, Bianchini M, et al. Agreement between wedged hepatic venous pressure and portal pressure in non-alcoholic steatohepatitis-related cirrhosis. J Hepatol Netherlands. 2021;74:811–8.
doi: 10.1016/j.jhep.2020.10.003
Bassegoda O, Olivas P, Turco L, Mandorfer M, Serra-Burriel M, Tellez L, et al. Decompensation in advanced nonalcoholic fatty liver disease may occur at lower hepatic venous pressure gradient levels than in patients with viral disease. Clin Gastroenterol Hepatol. United States; 2021;S1542–3565.
Agarwal L, Sahu AK, Baksi A, Agarwal A, Aggarwal S. Safety of metabolic and bariatric surgery in obese patients with liver cirrhosis: a systematic review and meta-analysis. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. United States. 2021;17:525–37.
Choi SB, Kim HJ, Song TJ, Ahn HS, Choi SY. Influence of clinically significant portal hypertension on surgical outcomes and survival following hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis. J Hepatobiliary Pancreat Sci Japan. 2014;21:639–47.
doi: 10.1002/jhbp.124
Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. Cochrane Handb. Syst. Rev. Interv. Cochrane B. Ser: John Wiley and Sons; 2008.
doi: 10.1002/9780470712184
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLOS Med [Internet] Public Lib Sci. 2009;6:e1000100. https://doi.org/10.1371/2Fjournal.pmed.1000100 (Available from).
doi: 10.1371/2Fjournal.pmed.1000100
Robinson KA, Dickersin K. Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol. 2002;31:150–3.
doi: 10.1093/ije/31.1.150
Biondi-Zoccai GGL, Agostoni P, Abbate A, Testa L, Burzotta F. A simple hint to improve Robinson and Dickersin’s highly sensitive PubMed search strategy for controlled clinical trials. Int J Epidemiol. 2005;34:224–5.
doi: 10.1093/ije/dyh311
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:210.
doi: 10.1186/s13643-016-0384-4
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg Blackwell Science Pty. 2003;73:712–6.
doi: 10.1046/j.1445-2197.2003.02748.x
Pestana L, Swain J, Dierkhising R, Kendrick ML, Kamath PS, Watt KD. Bariatric surgery in patients with cirrhosis with and without portal hypertension: a single-center experience. Mayo Clin Proc England. 2015;90:209–15.
doi: 10.1016/j.mayocp.2014.11.012
Bhambri A, Singla V, Kaul A, Shalimar, Kashyap L, Aggarwal S. Surgical management of super-super obesity with grade III esophageal varices and liver cirrhosis: the ultimate challenge. Asian J. Endosc. Surg. Japan; 2021. p. 570–3.
Christian DJ, Khithani A, Castro-Arreola ME, Levitan D, Jeyarajah DR. Surgical management of gastric varices and morbid obesity: a novel approach. Surg Obes Relat Dis Off J Am Soc Bariatr Surg United States. 2010;6:448–50.
Frey S, Petrucciani N, Iannelli A. Bariatric surgery in the setting of liver cirrhosis with portal hypertension: the confection and particularities of Roux-en-Y Gastric bypass in a high-risk patient. Obes Surg United States. 2020;30:4165–6.
doi: 10.1007/s11695-020-04715-w
Mittal T, Ahuja A, Dey A, Malik VK, Sheikh MTM, Bansal NK, et al. Safety and efficacy of laparoscopic sleeve gastrectomy in patients with portal hypertension with liver function of Childs A. Germany: Surg Endosc; 2021.
Hanipah ZN, Punchai S, McCullough A, Dasarathy S, Brethauer SA, Aminian A, et al. Bariatric surgery in patients with cirrhosis and portal hypertension. Obes Surg United States. 2018;28:3431–8.
doi: 10.1007/s11695-018-3372-z
Sarr MG. Is a bariatric procedure appropriate in patients with portal hypertension secondary to cirrhosis? Surg Obes Relat Dis Elsevier. 2006;2:405–6.
doi: 10.1016/j.soard.2006.01.012
Jan A, Narwaria M, Mahawar KK. A systematic review of bariatric surgery in patients with liver cirrhosis. Obes Surg United States. 2015;25:1518–26.
doi: 10.1007/s11695-015-1727-2
Ahmed S, Pouwels S, Parmar C, Kassir R, de Luca M, Graham Y, et al. Outcomes of bariatric surgery in patients with liver cirrhosis: a systematic review. Obes Surg United States. 2021;31:2255–67.
doi: 10.1007/s11695-021-05289-x
Vuppalanchi R, McCabe ME 4th, Tandra SR, Parcha SP, Ghafoor A, Schuh L, et al. Safety and efficacy of bariatric surgery in cirrhosis patients with extreme obesity. Ann Surg United States. 2022;275:e174–80.
doi: 10.1097/SLA.0000000000003891
Bischoff SC, Barazzoni R, Busetto L, Campmans-Kuijpers M, Cardinale V, Chermesh I, et al. European guideline on obesity care in patients with gastrointestinal and liver diseases - Joint European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline. United Eur Gastroenterol J. 2022;10:663–720.
doi: 10.1002/ueg2.12280
Shahabi S, Carbajo M, Nimeri A, Kermansaravi M, Davarpanah Jazi AH, Pazouki A, et al. Factors that make bariatric surgery technically challenging: a survey of 370 bariatric surgeons. World J Surg United States. 2021;45:2521–8.
doi: 10.1007/s00268-021-06139-8
Mumtaz K, Lipshultz H, Jalil S, Porter K, Li N, Kelly SG, et al. Bariatric surgery in patients with cirrhosis: careful patient and surgery-type selection is key to improving outcomes. Obes Surg United States. 2020;30:3444–52.
doi: 10.1007/s11695-020-04583-4
Lassailly G, Caiazzo R, Ntandja-Wandji L-C, Gnemmi V, Baud G, Verkindt H, et al. Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis. Gastroenterology United States. 2020;159:1290-1301.e5.
Fakhry TK, Mhaskar R, Schwitalla T, Muradova E, Gonzalvo JP, Murr MM. Bariatric surgery improves nonalcoholic fatty liver disease: a contemporary systematic review and meta-analysis. Surg Obes Relat Dis Off J Am Soc Bariatr Surg United States. 2019;15:502–11.
Mosko JD, Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol United States. 2011;9:897–901.
doi: 10.1016/j.cgh.2011.07.007