Treating morbid obesity in cirrhosis: A quest of holy grail

Table 1 Newer weight reduction drugs in pipeline

Drug	Mechanism of action
Cetilistat	Gastrointestinal and pancreatic lipase inhibitor
Velneperit	Neuropeptide Y5 receptor inhibitor, appetite suppression
Tesofensine	Inhibition of serotonin, dopamine, and noradrenaline reuptake
Metreleptin	Leptin receptor agonist
Obinepitide	Dual neuropeptide Y2/Y4 receptor agonist
Beloranib	MetAP2 inhibition

MetAP2: Methionine aminopeptidase 2.

Table 2 Studies of bariatric surgery in cirrhotic patients

Ref.	Study characteristics	Cirrhosis diagnosis	Child pugh	Procedures	Complications	Liver decompensation	Mortality
Pestana et al[74]	Mean age = 55.5 yr	Known cirrhosis	A = 14	SG = 11	0	1 (late HE)	0
n = 14				RYGB = 3
F:M = 10:4
Shimizu et al[73]	Mean age = 51.5 yr	12 preoperatively	A = 22	RYGB = 14	8	0	0
n = 23	Mean BMI = 48.2 kg/m2	11 intraoperatively	B = 1	SG = 8
F:M = 14:9	Mean stay = 4.3 d			AGB = 1
Rebibo et al[78]	Median age = 52 yr	All intraoperatively	A = 13	SG = 13	2	1 (ascites)	0
n = 13	Median BMI = 46.3 kg/m2
F:M = 7:6
Takata et al[71]	Mean age = 52 yr	All preoperatively	A = 4	SG = 6	2	1 (ascites)	0
n = 6	Mean BMI = 49 kg/m2		B = 2			1 (HE)
F:M = 4:2
Dallal et al[76]	Mean age = 50 yr	Diagnosed intraoperatively	A = 30	RYGB = 27	9	0	0
n = 30	Mean BMI = 52.6 kg/m2	in 27 (90%)		SG = 3
F:M = 20:20	Mean hospital stay = 4 d
Kral et al[77]	Mean age = 40 yr	All intraoperatively	NA	BPD = 14	2	2	2 (one late
n = 14	Mean BMI = 54 kg/m2						hepatic failure)
F:M = 10:4
Woodford et al[75]	Mean age = 52.5 yr	All intraoperatively	A or B	AGB = 14	2	0	0
n = 14	Mean BMI = 38.9 kg/m2
F:M = 10:4

RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy; BPD: Bilio-pancreatic diversion; AGB: Adjustable gastric banding; HE: Hepatic encephalopathy; M: Male; F: Female; BMI: Body mass index.