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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2020; 12(10): 709-721
Published online Oct 27, 2020. doi: 10.4254/wjh.v12.i10.709
Metabolic syndrome and liver disease in the era of bariatric surgery: What you need to know!
Ioannis A Ziogas, Konstantinos Zapsalis, Dimitrios Giannis, Georgios Tsoulfas
Ioannis A Ziogas, Konstantinos Zapsalis, Aristotle University School of Medicine, Thessaloniki 54124, Greece
Dimitrios Giannis, Center for Health Innovations and Outcomes Research (CHIOR), The Feinstein Institute for Medical Research, Manhasset, NY 11030, United States
Georgios Tsoulfas, The First Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
Author contributions: Ziogas IA and Zapsalis K contributed to this paper equally. Tsoulfas G and Ziogas IA contributed to conception and design; Zapsalis K, Ziogas IA, Giannis D, and Tsoulfas G contributed to acquisition, analysis, and interpretation of data; Ziogas IA, Zapsalis K, and Giannis D contributed to drafting of the manuscript; Ziogas IA, Zapsalis K, Giannis D, and Tsoulfas G contributed to critical revision and final approval.
Conflict-of-interest statement: All the authors would like to declare that there is no conflict of interest
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Georgios Tsoulfas, FACS, FICS, MD, PhD, Associate Professor, The First Department of Surgery, Aristotle University of Thessaloniki, 66 Tsimiski Street, Thessaloniki 54124, Greece. tsoulfasg@auth.gr
Received: June 11, 2020
Peer-review started: June 11, 2020
First decision: July 30, 2020
Revised: August 10, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: October 27, 2020
Abstract

Metabolic syndrome (MS) is defined as the constellation of obesity, insulin resistance, high serum triglycerides, low high-density lipoprotein cholesterol, and high blood pressure. It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare, cost, and quality of life associated consequences. MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease. Conservative treatment, which includes diet, exercise, and antidiabetic agents, is the mainstay of treatment, but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations. Bariatric surgery has recently emerged as an appropriate alternative treatment with promising long-term results. Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates. Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with non-alcoholic steatohepatitis has increased more than fivefold over the past 15 years. In this review, we summarize current state of evidence on the surgical treatment of MS.

Keywords: Metabolic syndrome, Bariatric surgery, Sleeve gastrectomy, Gastric bypass, Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Liver transplantation

Core Tip: Metabolic syndrome (MS) is increasingly common in developed countries, and is associated with cardiovascular disease, hyperlipidemia, and non-alcoholic steatohepatitis. Diet, exercise, and weight loss are the milestones of conservative management. Bariatric surgery has emerged as a promising treatment in severely obese patients or in patients with MS resistant to conservative measures. Sleeve gastrectomy and Roux-en-Y gastric bypass are the most commonly performed bariatric procedures. The only definitive treatment in patients with MS and end-stage liver disease secondary to non-alcoholic steatohepatitis is liver transplantation (LT). The optimal timing for bariatric surgery, when required along with LT, has yet to be determined.