Metabolic Surgery Shows Promise in MASH Treatment, Experts Say
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A new discussion highlights the potential of bariatric surgery as a viable treatment option for metabolic dysfunction-associated steatohepatitis (MASH), alongside emerging pharmacologic therapies.
Leading hepatology experts convened by MedPage Today recently explored the evolving landscape of MASH treatment,focusing on the role of metabolic surgery and how clinicians can best advise patients navigating these options. The virtual roundtable featured moderator Sobia Laique, MD, of the Cleveland Clinic, alongside naim Alkhouri, MD, of summit Clinical Research in San Antonio, and Meena Bansal, MD, of Mount Sinai in New York City.This discussion was the fourth in a five-part series.
Weighing Surgical Intervention Against Medication
With a growing number of pharmacotherapy options on the horizon for MASH patients,a key question arises: where does metabolic surgery fit into the treatment paradigm? According to one expert,metabolic surgery has a well-established track record. “Metabolic surgery has been around for a while, and there’s a number of studies that have shown the benefit of metabolic surgery on fibrosis regression, on even recently cirrhosis regression, which is fantastic, and also improvements in overall mortality, improvements in cardiovascular mortality,” they stated.
The core principle driving positive outcomes, experts emphasized, is important weight loss. “The bottom line is the weight loss helps,” one participant explained. “So however you get to that weight loss,whether that be pharmacologic,whether that be surgical,the end result,if you can achieve that greater than 10% weight loss,even 15% or 20%,that is going to be associated with improved clinical outcomes – cardiovascular outcomes and certainly liver-related outcomes.”
The decision between surgery and medication isn’t one-size-fits-all. Experts stressed the importance of shared decision-making with patients, acknowledging individual preferences and concerns. “Some people don’t want to take a medication their whole life. Some people are afraid of surgery,” one expert noted. “So again, we have to engage with the patient and see what works best for them.”
Cleveland Clinic Research Supports Surgical Benefits
Research from the Cleveland Clinic Bariatric Surgery team has provided compelling evidence supporting the benefits of surgery in MASH patients. One expert highlighted the team’s work,stating,”You guys do a marvelous job at the Cleveland Clinic actually generating the evidence needed to support the role of bariatric surgery,not onyl on MASH resolution and fibrosis regression,but in fact on the hard outcomes that matter the moast to clinicians and patients.”
Studies have demonstrated significant reductions in liver-related complications and improved long-term outcomes in patients with varying degrees of fibrosis (F1/F2/F3) and even compensated cirrhosis following bariatric surgery. These benefits include preventing serious conditions like ascites, encephalopathy, and variceal bleeding, as well as reducing the need for liver transplants and decreasing overall mortality.
Ultimately, the evolving treatment landscape for MASH offers patients more options than ever before, and a collaborative approach between clinicians and
