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Erschienen in: Obesity Surgery 11/2016

19.04.2016 | Original Contributions

Influence of Roux-en-Y Gastric Bypass on the Hepatocellular Function and Bile Flow of Obese Patients Assessed by Scintigraphy with DISIDA

verfasst von: Wilson Salgado Júnior, Carlos Augusto de Mattos Donadelli, José Sebastião dos Santos, Carla Barbosa Nonino

Erschienen in: Obesity Surgery | Ausgabe 11/2016

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Abstract

Background

Obesity is associated with nonalcoholic fatty liver disease (NAFLD), which is improved by bariatric surgery. Hepatobiliary scintigraphy with 99m.-Tc diisopropylacetanilido iminodiacetic acid (99mTc-DISIDA) has proved to be highly effective for the assessment of bile flow, representing an indirect measurement of hepatocyte and cholangiocyte function. The objective of this study was to assess the effects of Roux-en-Y gastric bypass (RYGB) on bile flow in obese subjects by hepatobiliary scintigraphy. This study was conducted in a public university hospital in Brazil.

Methods

Twenty obese patients and five nonobese patients (with no hepatic or biliary disease) were studied. The obese patients were submitted to anthropometric evaluation and biochemical exams when they arrived at the service, during the immediate preoperative period and 3, 6, and 12 months after surgery. They were also submitted to abdominal ultrasound and hepatobiliary scintigraphy with 99mTc-DISIDA during the preoperative period and 12 months after RYGB. Tmax (time of maximum marker uptake) and T1/2 (half time between peak uptake and disappearance of the marker) were determined and compared between obese patients and controls, before and after surgery. The results were compared to those obtained with an intraoperative liver biopsy.

Results

A weight loss of 12.2 ± 4.3 % was observed during preparation for surgery, and a loss of 30.4 ± 5.6 % was observed 1 year after RYGB. Ultrasound hepatic analysis revealed some degree of NAFLD in the operated patients. Obese patients showed a prolonged T1/2 compared to control, with a reduction to normal levels after RYGB.

Conclusions

We concluded that NAFLD compromises bile excretion, a process that can be reversed by treatment with RYGB.
Literatur
1.
Zurück zum Zitat Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMed Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMed
2.
Zurück zum Zitat Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254:267–73.CrossRefPubMed Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254:267–73.CrossRefPubMed
3.
Zurück zum Zitat Hamaguchi M, Kojima T, Takeda N, et al. The metabolic syndrome as a predictor of nonalcoholic fatty liver disease. Ann Intern Med. 2005;143:722–8.CrossRefPubMed Hamaguchi M, Kojima T, Takeda N, et al. The metabolic syndrome as a predictor of nonalcoholic fatty liver disease. Ann Intern Med. 2005;143:722–8.CrossRefPubMed
4.
Zurück zum Zitat Neuschwander-Tetri BA. Fatty liver and the metabolic syndrome. Curr Opin Gastroenterol. 2007;23:193–8.CrossRefPubMed Neuschwander-Tetri BA. Fatty liver and the metabolic syndrome. Curr Opin Gastroenterol. 2007;23:193–8.CrossRefPubMed
5.
Zurück zum Zitat Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:S99–S112.CrossRefPubMed Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: from steatosis to cirrhosis. Hepatology. 2006;43:S99–S112.CrossRefPubMed
6.
7.
Zurück zum Zitat Luyckx FH, Desaive C, Thiry A, et al. Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord. 1998;22:222–6.CrossRefPubMed Luyckx FH, Desaive C, Thiry A, et al. Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord. 1998;22:222–6.CrossRefPubMed
8.
Zurück zum Zitat Furuya Jr CK, de Oliveira CP, de Mello ES, et al. Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol. 2007;22(4):510–4.CrossRefPubMed Furuya Jr CK, de Oliveira CP, de Mello ES, et al. Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol. 2007;22(4):510–4.CrossRefPubMed
9.
Zurück zum Zitat Mummadi RR, Kasturi KS, Chennareddygari S, et al. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6(12):1396–402.CrossRefPubMed Mummadi RR, Kasturi KS, Chennareddygari S, et al. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6(12):1396–402.CrossRefPubMed
10.
Zurück zum Zitat Moretto M, Kupski C, da Silva VD, et al. Effect of bariatric surgery on liver fibrosis. Obes Surg. 2012;22(7):1044–9.CrossRefPubMed Moretto M, Kupski C, da Silva VD, et al. Effect of bariatric surgery on liver fibrosis. Obes Surg. 2012;22(7):1044–9.CrossRefPubMed
11.
Zurück zum Zitat Dowman JK, Tomlinson JW, Newsome PN. Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2011;33(5):525–40.CrossRefPubMed Dowman JK, Tomlinson JW, Newsome PN. Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2011;33(5):525–40.CrossRefPubMed
12.
Zurück zum Zitat Mueller M, Kratzer W, Oeztuerk S, et al. Percutaneous ultrasonographically guided liver punctures: an analysis of 1961 patients over a period of ten years. BMC Gastroenterol. 2012;12:173.CrossRefPubMedPubMedCentral Mueller M, Kratzer W, Oeztuerk S, et al. Percutaneous ultrasonographically guided liver punctures: an analysis of 1961 patients over a period of ten years. BMC Gastroenterol. 2012;12:173.CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Masuda K, Ono M, Fukumoto M, et al. Usefulness of technetium-99 m-2-methoxy-isobutyl-isonitrile liver scintigraphy for evaluating disease activity of non-alcoholic fatty liver disease. Hepatol Res. 2012;42(3):273–9.CrossRefPubMed Masuda K, Ono M, Fukumoto M, et al. Usefulness of technetium-99 m-2-methoxy-isobutyl-isonitrile liver scintigraphy for evaluating disease activity of non-alcoholic fatty liver disease. Hepatol Res. 2012;42(3):273–9.CrossRefPubMed
14.
Zurück zum Zitat Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.CrossRefPubMed Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.CrossRefPubMed
15.
Zurück zum Zitat Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304–11.PubMed Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304–11.PubMed
16.
Zurück zum Zitat Tarnoff M, Kaplan LM, Shikora S. An evidence-based assessment of preoperative weight loss in bariatric surgery. Obes Surg. 2008;18(9):1059–61.CrossRefPubMed Tarnoff M, Kaplan LM, Shikora S. An evidence-based assessment of preoperative weight loss in bariatric surgery. Obes Surg. 2008;18(9):1059–61.CrossRefPubMed
17.
Zurück zum Zitat Shimada M, Hashimoto E, Kaneda H, et al. Nonalcoholic steatohepatitis: risk factors for liver fibrosis. Hepatol Res. 2002;24(4):429–38.CrossRefPubMed Shimada M, Hashimoto E, Kaneda H, et al. Nonalcoholic steatohepatitis: risk factors for liver fibrosis. Hepatol Res. 2002;24(4):429–38.CrossRefPubMed
19.
Zurück zum Zitat Dyson JK, Anstee QM, Mcpherson S. Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging. Frontline Gastroenterol. 2014;5(3):211–8.CrossRefPubMed Dyson JK, Anstee QM, Mcpherson S. Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging. Frontline Gastroenterol. 2014;5(3):211–8.CrossRefPubMed
20.
Zurück zum Zitat Ma H, Patti ME. Bile acids, obesity and the metabolic syndrome. Best Practice & Research Clinical Gastroenterology. 2014;28:533–44.CrossRef Ma H, Patti ME. Bile acids, obesity and the metabolic syndrome. Best Practice & Research Clinical Gastroenterology. 2014;28:533–44.CrossRef
21.
Zurück zum Zitat Penney NC, Kinross J, Newton RC, et al. The role of bile acids in reducing the metabolic complications of obesity after bariatric surgery: a systematic review. Int J Obes. 2015;39:1565–74.CrossRef Penney NC, Kinross J, Newton RC, et al. The role of bile acids in reducing the metabolic complications of obesity after bariatric surgery: a systematic review. Int J Obes. 2015;39:1565–74.CrossRef
22.
Zurück zum Zitat Glicksman C, Pournaras DJ, Wright M, et al. Postprandial plasma bile acid responses in normal weight and obese subjects. Ann Clin Biochem. 2010;47:482–4.CrossRefPubMed Glicksman C, Pournaras DJ, Wright M, et al. Postprandial plasma bile acid responses in normal weight and obese subjects. Ann Clin Biochem. 2010;47:482–4.CrossRefPubMed
23.
Zurück zum Zitat Okuda H, Nunes R, Vallabhajosula S, et al. Studies of the hepatocellular uptake of the hepatobiliary scintiscanning agent 99mTc-DISIDA. J Hepatol. 1986;3(2):251–9.CrossRefPubMed Okuda H, Nunes R, Vallabhajosula S, et al. Studies of the hepatocellular uptake of the hepatobiliary scintiscanning agent 99mTc-DISIDA. J Hepatol. 1986;3(2):251–9.CrossRefPubMed
24.
Zurück zum Zitat Kamisaka K, Gatmaitan Z, Moore CL, et al. Ligandin reverses bilirubin inhibition of liver mitochondrial respiration in vitro. Pediatr Res. 1975;9(12):903–5.CrossRefPubMed Kamisaka K, Gatmaitan Z, Moore CL, et al. Ligandin reverses bilirubin inhibition of liver mitochondrial respiration in vitro. Pediatr Res. 1975;9(12):903–5.CrossRefPubMed
25.
Zurück zum Zitat Pizarro M, Balasubramaniyan N, Solís N, et al. Bile secretory function in the obese Zucker rat: evidence of cholestasis and altered canalicular transport function. Gut. 2004;53(12):1837–43.CrossRefPubMedPubMedCentral Pizarro M, Balasubramaniyan N, Solís N, et al. Bile secretory function in the obese Zucker rat: evidence of cholestasis and altered canalicular transport function. Gut. 2004;53(12):1837–43.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Tilg H, Moschen AR. Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis. Hepatology. 2010;52(5):1836–46.CrossRefPubMed Tilg H, Moschen AR. Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis. Hepatology. 2010;52(5):1836–46.CrossRefPubMed
Metadaten
Titel
Influence of Roux-en-Y Gastric Bypass on the Hepatocellular Function and Bile Flow of Obese Patients Assessed by Scintigraphy with DISIDA
verfasst von
Wilson Salgado Júnior
Carlos Augusto de Mattos Donadelli
José Sebastião dos Santos
Carla Barbosa Nonino
Publikationsdatum
19.04.2016
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 11/2016
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2176-2

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