Guillaume Lassailly: How Do We Value Bariatric Surgery in 2023?

The role and understood value of bariatric surgery may be evolving in the treatment of fatty liver disease, though it may take some time for clinicians to appreciate that new value.

In the second segment of an interview with HCPLive during The Liver Meeting 2023 from the American Association for the Study of Liver Diseases (AASLD) in Boston this month, study author Guillaume Lassailly, from the Centre Hospitalier Universitaire de Lille in France, discussed the implications of his team’s real-world analysis of 15-year survival rates among patients who resolved metabolic dysfunction-associated steatohepatitis (MASH) without worsening fibrosis after bariatric surgery.

Though his team’s research showed such patients had markedly improved survival rates when achieving these markers after the surgery, Lassailly believes there remains a “mental bias” among clinicians who may have a patient eligible for bariatric surgery.

“Bariatric surgery is something that when you perform it, you can't go backwards,” Lassailly said. “When you have a drug effect, you can still stop the drug, which you can't do with bariatric surgery. So there's something in this treatment that is quite radical.”

Lassailly noted that the introduction of GLP-1 agonists to clinical obesity management strategies has added to the “opposition” against bariatric surgery. He argues the invasive procedure should be looked at as an “additive therapeutic,” not an opposing idea.

“And the way we can see it is you will have patients that will be more suitable for surgery because they're severe, they have a lot of metabolic comorbidities, and you really think that they will also benefit outside the liver with bariatric surgery,” Lasailly said. “And if this patient did not have sufficient weight loss, we can also think of adding drugs afterwards. And on the other hand, you can also proceed with drugs as a first strategy and then get to bariatric surgery.”

For now, clinicians are not operating with an understanding of which treatment should come first for which patient—caregivers must consider the full patient profile before choosing.

In discussing next steps for his team research, Lasailly said the field remains limited by the reliance of a liver biopsy to initiate care.

“I think the next step is to link biopsy with non-invasive markers, because at a patient point of view, liver biopsy is invasive, painful, and also has a cost,” he said. “And so, if you can reduce pain and reduce cost, well, you will win in all the fields.”