Liver disease in the morbidly obese is thought to occur due to the long-term presence of fat
deposits in the liver, resulting in inflammation and scarring of the liver over time, which
reduces liver function. However, many of these patients are unaware that their liver is
damaged. There is currently no consensus regarding what the long-term effects of gastric
bypass surgery are on pre-existing liver disease in morbidly obese patients. This study will
determine the long-term effects on the liver after this type of surgical procedure.
Before or on the day of surgery liver function will be determined using the DDG-2001
Analyzer. This monitor is able to detect the concentration of a dye called indocyanine green
dye (ICG) when present in the blood stream. A dose of 0.5 mg/kg of ICG will be injected into
an IV in the arm. Over approximately fifteen minutes the DDG-2001 Analyzer will determine how
quickly the liver removes the dye ICG from the blood stream. This value represents how well
the liver is functioning. Blood samples are drawn before injection of ICG to measure liver
function using standard liver function tests.
This same routine for injecting ICG and obtaining blood for routine liver function tests will
happen one more time, after surgery, once the subject has lost a significant amount of the
original weight (60% of excess weight). This amount of weight loss typically occurs between
12 to 18 months after gastric bypass surgery. This second ICG measurement will occur during
an outpatient follow-up visit to CCF.
A biopsy will be taken from the liver during surgery. A second biopsy taken after the 60%
weight loss will be compared to determine the effect of this surgery on the liver.
1. BMI > 40.
2. Documented failed non-surgical treatment for morbid obesity.
3. Ability to undergo long-term follow-up after LGBS.
1. BMI < 40.
2. Subject age < 18 years.
3. Inability to undergo long-term follow-up after LGBS (living distance > 300 miles).
4. Patients with known ESLD.
5. Patients found to have evidence of ESLD during preoperative evaluation for LGBS
including portal hypertension, ascites, and coagulopathy.
6. Patients with known iodine sensitivity or allergy.