Portal Hypetension and Bariatric Surgery (BARIAPORTAL)

Overview

The worldwide obesity epidemic has led to an increase in the proportion of patients with chronic liver disease due to non-alcoholic fatty liver disease (NAFLD) and in the prevalence of obesity in patients with cirrhosis of all etiologies. The reported prevalence of obesity in patients with cirrhosis is of 30% which appears similar to that of the general population. Bariatric surgery is currently considered as the most effective and durable means for the management of morbid obesity as it is associated with the remission and/or improvement of many obesity associated comorbidities as well as improved quality and expectancy of life. However, the surgical risk is increased compared to individuals without cirrhosis, and determining the risk/benefit ratio of bariatric surgery in the setting of cirrhosis is a complex task further hampered by the lack of randomized controlled trials. The Nationwide Inpatient Sample study reported a slightly increased rate of mortality of bariatric surgery in the setting of compensated cirrhosis compared to individuals without cirrhosis (0.9% vs 0.3%). Interestingly, this risk was as high as 16.3% in individuals with decompensated cirrhosis (16.3%). However, this study has been published more than 10 years ago and the mortality of bariatric surgery has decreased significantly and is around 0.1%. Furthermore, the introduction of transient elastography in clinical practice has allowed the early identification of patients with chronic liver disease (CLD) at risk of developing clinically significant portal hypertension (CSPH). A few series including a limited number of patients have been published indicating that CSPH should not be considered as a formal contraindication for bariatric surgery. This study is meant to assess the outcomes of bariatric surgery in patients with morbid obesity and compensated advanced chronic liver disease (cACLD) (currently synonymous of the term "compensated cirrhosis'') associated with clinically significant portal hypertension (CSPH) in a large multicentric, multinational series.

Full Title of Study: “Outcomes of Bariatric Surgery in the Setting of Compensated Advance+B9d Chronic Liver Disease Associated With Clinically Significant Portal Hypertension”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: April 30, 2023

Interventions

  • Procedure: Bariatric surgery
    • Bariatric surgery

Arms, Groups and Cohorts

  • Bariatric surgery
    • Individuals with morbid obesity and clinically relevant portal hypertension undergoing bariatric surgery

Clinical Trial Outcome Measures

Primary Measures

  • Postoperative mortality
    • Time Frame: Within 90 of surgery or any tipe during postoperative hospital stay
    • number of patients who died after the surgery

Secondary Measures

  • General information and anthropometrics
    • Time Frame: through study completion on average 1 year
    • Age (years), gender (male/ female), body weight (Kg), height (meters), BMI (body weight in Kg/height in meters); obesity linked comorbid conditions : hypertension (HT is defined as resting blood pressure persistently ≥ 140/90 mmHg or need for antihypertensive drugs), Type 2 diabetes (T2D is defined as fasting glucose > 7.0 mmol/L after two measurements or need for oral antidiabetics), sleep apnea syndrome (SAS is quantified by sleep studies).
  • Etiology of liver cirrhosis
    • Time Frame: through study completion on average 1 year
    • viral (HCV, HBV), NASH, Alcohol, other
  • Preoperative work-up to define CSPH
    • Time Frame: through study completion on average 1 year
    • endoscopy (presence of varices), imaging CT scan (presence of porto-systemic shunts), MRI (presence of porto-systemic shunts), portal pressure measure (mmHg).
  • Liver function
    • Time Frame: through study completion on average 1 year
    • Child’s score (Child A 5-6 points; Child B 7-9; Child C 10-15), Model for End-Stage Liver Disease (MELD) score (number of points up to 40)
  • Strategy to lower portal hypertension
    • Time Frame: through study completion on average 1 year
    • TIPS, Beta blockers
  • Type of bariatric procedure
    • Time Frame: through study completion on average 1 year
    • SG, RYGB, Band, other
  • Postoperative complications
    • Time Frame: through study completion on average 1 year
    • bleeding, leak, pulmonary embolus, stricture, other
  • Functional results
    • Time Frame: through study completion on average 1 year
    • weight loss in Kg as compared to preoperative weight

Participating in This Clinical Trial

Inclusion Criteria

  • Individuals with morbid obesity (BMI > 40 or 35 with at least one comorbidity) undergoing bariatric surgery and CSPH (defined as HVPG > 10 mmHg and/or cross-sectional imaging showing collateral circulation, and/or varices at esophagogastroduodenoscopy. – Information available to determine postoperative mortality (at least first postoperative month of any duration in case of primary hospitalization longer than 1 month) Exclusion Criteria:

  • Absence of preoperative evidence of CSPH in spite of evidence liver cirrhosis. – Absence of information to determine at least postoperative mortality.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 65 Years

Investigator Details

  • Lead Sponsor
    • Centre Hospitalier Universitaire de Nice
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Contact(s)
    • Antonio IANNELLI, +33492036376, iannelli.a@chu-nice.fr

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.