Sleeve gastrectomy (SG) was associated with lower rates of liver disease progression and hepatic decompensation compared with Roux-en-Y gastric bypass (RYGB) in patients with nonalcoholic fatty liver disease (NAFLD), according to a large retrospective cohort study using real-world data presented at Digestive Disease Week 2026.

The findings suggest that bariatric procedure type may influence long-term hepatic outcomes.

Investigators analyzed 32,708 matched patients with NAFLD or nonalcoholic steatohepatitis who underwent SG or RYGB, using data from the TriNetX Research Network. Outcomes were assessed from six months to 10 years following surgery and included cirrhosis progression, ascites, hepatic encephalopathy, varices, liver transplant, hepatocellular carcinoma (HCC), and all-cause mortality.

Compared with RYGB, SG was associated with significantly lower risks of multiple hepatic outcomes. Rates of cirrhosis progression were 1.9% with SG versus 2.6% with RYGB (risk ratio [RR], 0.72), while ascites occurred in 1.7% versus 2.9% (RR, 0.58). Hepatic encephalopathy (0.5% vs 0.8%; RR, 0.60) and varices (0.3% vs 0.5%; RR, 0.68) were also less frequent with SG. All-cause mortality was lower in the SG group (1.5% vs 1.8%; RR, 0.79).

The authors reported that “sleeve gastrectomy was associated with significantly lower risk of liver disease progression and hepatic decompensation compared with Roux-en-Y gastric bypass.” They noted that HCC incidence was “low and similar between groups.”

Kaplan–Meier analyses confirmed higher cumulative rates of hepatic decompensation among patients undergoing RYGB.

Reference
Nanda E, Sharma R, Kansagra V, et al. Sleeve gastrectomy is associated with lower risk of liver disease progression compared with Roux-en-Y gastric bypass in NAFLD: a 32,000-patient propensity-matched study. Presented at: Digestive Disease Week; May 2–5, 2026; Chicago, Illinois.