Metabolic Bariatric Surgery for the Treatment of Metabolic Dysfunction-Associated Steatohepatitis (MASH): A Scoping Review of Biomarker and Histology Changes

The global obesity epidemic is responsible for the rise in metabolic dysfunction-associated steatotic liver disease (MASLD) and its advanced form, metabolic dysfunction-associated steatohepatitis (MASH). Metabolic bariatric surgery (MBS) is emerging as an important treatment option for patients with MASH to address both hepatic histology and their metabolic health. This scoping review aims to evaluate the impact of MBS on metabolic parameters, biomarkers, and histologic liver outcomes in adults with biopsy-confirmed MASH following MBS. Following PRISMA guidelines, MEDLINE, EMBASE, Cochrane, and Google Scholar were searched from database inception to March 2025. Two reviewers independently screened and extracted data from studies on adults (≥ 18 years) with biopsy-confirmed MASH undergoing MBS, reporting changes in liver histology (steatosis, fibrosis, ballooning, inflammation) and/or metabolic biomarkers (glycemic control, lipid profile, liver enzymes). Fourteen studies with follow-up periods ranging from 6 months to 5 years were included. Significant improvements post-MBS were observed in glycemic markers – fasting glucose, insulin resistance, HbA1c; lipid profiles – triglycerides, HDL, LDL; and liver enzymes – AST, ALT. These frequently correlated with improvements in liver histology: regression in steatosis, fibrosis, and ballooning and inflammation, and therefore an improvement in overall MASH severity where reported as index scores. MBS is associated with metabolic (glucose metabolism, lipid profiles) and histological liver improvements (regression of fibrosis and inflammation) in patients with MASH. Future research should focus on biomarker standardization, criteria for patient selection and pre-op optimization, and long-term comparisons of MBS versus pharmacotherapy to refine clinical guidelines for management of MASH.