Insulin resistance and hepatic histological changes after bariatric surgery for severe obesity with NASH

• Project/Area Number: 15K10065
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: General surgery
• Research Institution: Iwate Medical University
• Principal Investigator: Sasaki Akira 岩手医科大学, 医学部, 教授 (40275540)
• Co-Investigator(Kenkyū-buntansha): 石垣 泰 岩手医科大学, 医学部, 教授 (50375002)
• Research Collaborator: BABA Shigeaki ; UMEMURA Akira ; NIKAI Haruka
• Project Period (FY): 2015-04-01 – 2018-03-31
• Project Status: Completed (Fiscal Year 2017)
• Budget Amount: ¥3,900,000 (Direct Cost: ¥3,000,000、Indirect Cost: ¥900,000); Fiscal Year 2017: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2016: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2015: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
• Keywords: 肥満症 / 非アルコール性脂肪性肝疾患 / 非アルコール性脂肪性肝炎 / インスリン抵抗性 / 肥満外科手術 / 腸内細菌 / ヘパトカイン / 糖尿病

Outline of Final Research Achievements

The aim of the present study was to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on nonalcoholic steatohepatitis (NASH).Seventy-four patients with severe obesity underwent LSG and concomitant intra-operative liver biopsies from 2008 to 2017. Fifty-one patients fulfilled criteria for NASH and 22 patients underwent repeat percutaneous liver biopsy at 1 year after LSG. Mean excess body weight loss at time of repeat biopsy was 57.0%. Mean NAFLD activity score was decreased from 4.7 to 0.2. At the second biopsy, steatosis resolved in 62%, lobular inflammation resolved in 39%, ballooning resolved in 69%, and fibrosis resolved in 39%. Significant differences were observed in the following variables pre- and post-LSG: HOMA-IR (6.3 vs 1.7), liver volume (2,265 vs 1,598 mL), and visceral adipose tissue (271 vs 148 cm2). Metabolic surgery-induced weight loss should be considered as a treatment of choice for NASH patients with severe obesity.

Research Products

• [Journal Article] Long-term outcomes of bariatric and metabolic surgery in Japan: Results of a multi-institutional survey (2016)
  • Author(s): Haruta H, Kasama K, Ohta M, Sasaki A, Yamamoto H, Miyazaki Y, Oshiro T, Naitoh T, Hosoya Y, Togawa T, Seki Y, Lefor AK, Tani T
  • Journal Title: Obesity Surgery Volume: 27(3) Issue: 3 Pages: 754-762
  • DOI: 10.1007/s11695-016-2361-3
  • Peer Reviewed / Open Access
• [Journal Article] 高度肥満症を伴う非アルコール性脂肪性肝炎に対する肥満外科手術の効果 (2016)
  • Author(s): 佐々木章, 大塚幸喜, 新田浩幸, 肥田圭介, 水野 大
  • Journal Title: 外科と代謝・栄養 Volume: 50(4) Pages: 213-216
  • NAID: 130005290550
  • Peer Reviewed
• [Presentation] Effect of laparoscopic sleeve gastrectomy on nonalcoholic steatohepatitis in Japanese patients with severe obesity (2018)
  • Author(s): Sasaki A, Nitta H, Otsuka K, Baba S, Kimura T, Takahara T, Akiyama Y, Koeda K, Mizuno M
  • Organizer: 26th International Congress of the European Association for Endosopic Surgery
  • Int'l Joint Research
• [Presentation] Current status and prospects for bariatric and metabolic surgery in Japan (2018)
  • Author(s): Sasaki A, Nitta H, Otsuka K, Nikai H, Baba B, Umemura A, Takahara T, Akiyama Y, Iwaya T, Ishigaki Y
  • Organizer: Asia Pacific Metabolic and Bariatric Surgery Society Congress 2018
  • Int'l Joint Research
• [Presentation] 腹腔鏡下スリーブ状胃切除術後における非アルコール性脂肪性肝炎の組織学的評価 (2018)
  • Author(s): 二階春香, 馬場誠朗, 梅邑 晃, 木村聡元, 高原武志, 秋山有史, 岩谷 岳, 新田浩幸, 大塚幸喜, 水野 大, 佐々木章
  • Organizer: 第36回日本肥満症治療学会学術集会
• [Presentation] 高度肥満症に対する腹腔鏡下スリーブ状胃切除術:周術期栄養管理と成績 (2017)
  • Author(s): 佐々木章, 新田浩幸, 大塚幸喜, 高原武志, 秋山有史, 岩谷 岳, 肥田圭介, 水野 大
  • Organizer: 第20回日本病態栄養学会年次学術集会
  • Place of Presentation: 京都
  • Year and Date: 2017-01-13
• [Presentation] Impact sleeve gastrectomy with duodena-jejunal bypass for the treatment of T2DM with low ABCD score patients in Japan (2017)
  • Author(s): Imoto H, Kasama K, Seki Y, Ohta M, Oshiro T, Sasaki A, Miyazaki Y, Yamaguchi T, Hayashi H, Tanaka N, Naitoh T
  • Organizer: 22nd World Congress of International Federation for the Surgery of Obesity and Metabolic Disorders
  • Int'l Joint Research
• [Presentation] Current status and future perspective of bariatric and metabolic surgery (2017)
  • Author(s): 佐々木章, 新田浩幸, 大塚幸喜, 馬場誠朗, 梅邑 晃, 高原武志, 秋山有史, 岩谷 岳, 肥田圭介, 水野 大
  • Organizer: 第30回日本内視鏡外科学会
• [Presentation] 肥満・糖尿病外科治療の可能性と今後の展望 (2017)
  • Author(s): 佐々木章
  • Organizer: 第48回日本消化吸収学会総会
• [Presentation] 腹腔鏡下スリーブ状胃切除術の成績 (2017)
  • Author(s): 佐々木章, 大塚幸喜, 新田浩幸
  • Organizer: 第25回日本消化器病週間
• [Presentation] Metabolic surgeryの期待とその準備 (2017)
  • Author(s): 佐々木章
  • Organizer: 第117回日本外科学会定期学術集会
• [Presentation] 高度肥満症に対する腹腔鏡下スリーブ状胃切除術:代謝手術としての効果と本邦における課題 (2016)
  • Author(s): 佐々木章, 大塚幸喜, 新田浩幸, 馬場誠朗, 梅邑 晃, 高原武志, 秋山有史, 岩谷 岳, 西塚 哲, 肥田圭介, 水野 大
  • Organizer: JDDW 2016 Kobe
  • Place of Presentation: 神戸
  • Year and Date: 2016-11-03
• [Presentation] Effect of laparoscopic sleeve gastrectomy on nonalcoholic steatohepatitis in Japanese patients with severe obesity (2016)
  • Author(s): Sasaki A, Otsuka K, Nitta H, Baba S, Takahara T, Akiyama Y, Iwaya T, Nishizuka S, Koeda K, Mizuno M, Ishigaki Y, Ishida K, Sugai T
  • Organizer: The 2016 Obesity Summit
  • Place of Presentation: London
  • Year and Date: 2016-04-12
  • Int'l Joint Research
• [Presentation] 高度肥満症・2型糖尿病に対する外科治療:多職種連携と臨床研究 (2015)
  • Author(s): 1.佐々木章,新田浩幸,大塚幸喜,安藤太朗,梅邑 晃,馬場誠朗,秋山有史,岩谷 岳,西塚 哲,柏葉匡寛,肥田圭介,水野 大,木村祐輔
  • Organizer: 第28回日本内視鏡外科学会総会
  • Place of Presentation: 大阪国際会議場（大坂）
  • Year and Date: 2015-12-10