Alcohol-Related Liver Disease After Metabolic Bariatric Surgery: Reassessing the Hidden Risk-A Meta-Analysis

To evaluate whether metabolic bariatric surgery (MBS) influences the risk of alcohol-related liver disease (ARLD), particularly alcoholic cirrhosis, and assess its long-term hepatic implications.

This study followed PRISMA guidelines and was prospectively registered in PROSPERO. PubMed, Embase, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to 26 December 2025 for observational cohort studies comparing the incidence of alcoholic cirrhosis between MBS patients and matched non-surgical controls. Data extraction and quality assessment were independently performed, and pooled effect sizes were calculated using random-effects models. Subgroup, sensitivity, and publication bias analyses were conducted. Statistical analyses were performed using Stata 17.0.

Five studies were included. The overall association between MBS and alcohol-related cirrhosis was not statistically significant (OR 1.18, 95% CI 0.91-1.53; p = 0.214), with substantial heterogeneity (I² = 97.5%). However, significantly increased odds were observed in studies with sample sizes ≥ 1,000,000 and in those with follow-up durations ≥ 10 years. Leave-one-out analysis showed that no single study substantially altered the pooled estimate, and Begg's and Egger's tests detected no significant publication bias.

Current evidence does not show a significant overall association between MBS and alcohol-related cirrhosis. However, substantial heterogeneity and increased odds in large-sample and long-term studies preclude firm conclusions regarding long-term hepatic safety.