Outcomes of adolescent bariatric surgery: liver disease

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing among children in the United States as pediatric obesity rates continue to rise. As such, metabolic and bariatric surgery (MBS) has become a more recognized option for treatment of obesity and has been recommended by the American Academy of Pediatrics. Although MBS is known to improve many obesity-associated comorbidities, such as hypertension and type 2 diabetes, less is known about its effect as a treatment for MASLD. This article reviewed the impact MBS has on the course of liver disease as measured by histopathology, serum markers, and radiographic imaging, among adolescents with severe obesity. Improvements were seen in alanine transaminase (ALT) liver enzymes, rates of hepatocyte steatosis, and degree of fibrosis on histopathology, and fat content in the liver on computed tomography and magnetic resonance imaging. Greater improvements in ALT were seen in patients with higher baseline values and/or a higher stage of biopsy-confirmed steatohepatitis. Biopsy-proven MASLD and metabolic dysfunction-associated steatohepatitis (MASH) have even been shown to disappear completely, but fibrosis does not completely resolve by 12 months post-MBS. To better understand the outcome of pediatric MASLD following MBS treatment, more longitudinal radiographic data and liver histology in patients with fibrosis would be informative beyond 12 months post-MBS.