Morbid obesity is strongly associated with non-alcoholic fatty liver disease (NAFLD), which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through lifestyle modification. Because of frustrating inefficiency of such a therapeutic approach bariatric surgery is increasingly seen in adolescents as an alternative option for weight reduction. Standards of care and consensus for indications however are scarce. We explore the indications and limitations of bariatric surgery in severely obese children with and without non-alcoholic steatohepatitis and aim to provide guidance for the exceptional indications for extremely obese adolescents with major comorbidity that may benefit from these controversial interventions. Current evidence suggests that bariatric surgery can decrease the grade of steatosis, hepatic inflammation and fibrosis in non-alcoholic steatohepatitis. Uncomplicated NAFLD is not an indication for bariatric surgery. Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents, as long as appropriate long-term follow-up is provided. Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational. Finally, sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults, still need to be considered investigational. Temporary devices may be increasingly being used in pediatrics, however future studies, including a long-term risk analysis of patients who undergo surgery, are much needed to clarify the exact indications for bariatric surgery in adolescents.

Indications and Limitations of Bariatric Intervention in Severely Obese Children and Adolescents With and Without Non-alcoholic Steatohepatitis: the ESPGHAN Hepatology Committee Position Statement

VAJRO, Pietro;
2015

Abstract

Morbid obesity is strongly associated with non-alcoholic fatty liver disease (NAFLD), which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through lifestyle modification. Because of frustrating inefficiency of such a therapeutic approach bariatric surgery is increasingly seen in adolescents as an alternative option for weight reduction. Standards of care and consensus for indications however are scarce. We explore the indications and limitations of bariatric surgery in severely obese children with and without non-alcoholic steatohepatitis and aim to provide guidance for the exceptional indications for extremely obese adolescents with major comorbidity that may benefit from these controversial interventions. Current evidence suggests that bariatric surgery can decrease the grade of steatosis, hepatic inflammation and fibrosis in non-alcoholic steatohepatitis. Uncomplicated NAFLD is not an indication for bariatric surgery. Roux-en-Y gastric bypass is considered a safe and effective option for extremely obese adolescents, as long as appropriate long-term follow-up is provided. Laparoscopic adjustable gastric banding has not been approved by the FDA for use in adolescents and therefore should be considered investigational. Finally, sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults, still need to be considered investigational. Temporary devices may be increasingly being used in pediatrics, however future studies, including a long-term risk analysis of patients who undergo surgery, are much needed to clarify the exact indications for bariatric surgery in adolescents.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11386/4568258
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