The early impact of bariatric surgery on metabolic dysfunction-associated steatotic liver disease (MASLD) as assessed by fibroscan at 6 months postoperatively.

MASLD is very common in patients with severe obesity. Fibroscan offers a non-invasive method of detecting and monitoring MASLD. This study aimed to assess the impact of bariatric surgery on MASLD using Fibroscan. Between November 2022 and December 2024, 165 patients undergoing bariatric surgical intervention were prospectively offered Fibroscan preoperatively and at six months postoperatively (mean 7 ± 1 months) if they had sonographic evidence of MASLD. Patient demographics, total weight loss percentage (TWL%), pre and postoperative BMI, Liver Stiffness Measurement (LSM), Controlled Attenuation Parameter (CAP) and associated medical problems were assessed. Based on validated studies and EASL clinical practice guidelines, a CAP score greater than 240 dB/m was defined as hepatic steatosis and LSM of greater than 7 kPa was defined as hepatic fibrosis for this study. Resolution of MASLD and hepatic fibrosis refers to the normalisation of CAP and LSM scores respectively and does not imply histological resolution. A total of 111 patients underwent pre- and postoperative Fibroscan. Preoperatively, the mean weight ± SD was 141 ± 25 kg and BMI was 49 ± 7 kg/m2. By 7 ± 1 months postoperatively, the mean weight loss was 43 ± 26 kg and TWL% was 27.6 ± 7% (p < 0.001). Preoperatively, MASLD decreased from 100%(111) to 61%(68) by 7 ± 1 months postoperatively (p < 0.001). Hepatic fibrosis decreased from 41%(45) to 8%(9) (p < 0.001). The mean reduction in CAP was 26% (p < 0.001) and the mean reduction in LSM was 33% (p < 0.001). Of eighteen patients with severe fibrosis (LSM > 12 kPa) 72% (13) demonstrated resolution by 7 ± 1 months postoperatively (p = 0.002). Bariatric surgery was associated with an improvement and, in many cases, total regression of MASLD by seven months postoperatively. Fibroscan may help identify nonresponders with persistently elevated CAP and LSM, who may benefit from additional weight loss measures including pharmacotherapy when weight loss has plateaued between 12 and 18 months postoperatively.