Mixed
Bariatric-metabolic surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) significantly increases the probability of histological NASH resolution without worsening fibrosis compared to lifestyle modification plus best medical care in patients with obesity and NASH.
For individuals with obesity and confirmed NASH, bariatric surgery (Roux-en-Y or sleeve gastrectomy) is a highly effective treatment for resolving liver inflammation and fibrosis, far outperforming lifestyle changes and medical therapy alone. This should be considered a primary treatment option for eligible patients.
In the intention-to-treat analysis, the percentage of participants who met the primary endpoint was significantly higher in the Roux-en-Y gastric bypass group (54 [56%]) and sleeve gastrectomy group (55 [57%]) compared with lifestyle modification (15 [16%]; p<0·0001).
Why this rating
Randomized controlled trial (RCT) with histological endpoints.
Source
Bariatric–metabolic surgery versus lifestyle intervention plus best medical care in non-alcoholic steatohepatitis (BRAVES): a multicentre, open-label, randomised trial
Ornella Verrastro et al. · The Lancet · 2023
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