Nikai H, Ishida K, Umemura A, et al. - The metabolic and histological effects of laparoscopic sleeve gastrectomy (LSG) on non-alcoholic steatohepatitis (NASH) and liver fibrosis in Japanese patients with severe obesity were investigated. Among 79 patients with severe obesity who underwent LSG between June 2008 and March 2019, 43 patients (63.2%) had NASH, and 10 patients had fibrosis without steatosis (a unique feature) at the time of LSG. Among 28 patients with NASH, 25 exhibited improvement and no longer fitted the diagnostic criteria of NASH at 12 months after LSG. In multivariate analysis, HbA1c was identified as the only preoperative predictor of improvement in fibrosis. Outcomes suggest the great potential of LSG as an effective treatment for patients with NASH.