New combo treatment aims to help patients with liver disease and obesity

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria 1. Candidate for general anesthesia. 2. Age 18-70 years at consent. 3. BMI 35-70 kg/m² at first study visit. 4. Eligible for sleeve gastrectomy per ASMBS/IFSO 2022 guidelines. 5. Insurance coverage for metabolic surgery. 6. Current or prior anti-obesity medication use permitted. 7. Liver cirrhosis confirmed by biopsy or non-invasive assessment. 8. Clinically significant portal hypertension (HVPG ≥ 10 mm Hg, or esophagogastric varices / portal-hypertensive gastropathy, or imaging evidence of collaterals/dilated portal vein). 9. Able and willing to provide informed consent and comply with study procedures. 10. Women of child-bearing potential: negative urine pregnancy test at screening and randomization and agreement to reliable contraception for 2 years. Exclusion Criteria 1. Prior bariatric/metabolic surgery (except removed devices ≥ 3 months earlier). 2. Prior complex foregut surgery. 3. History of solid-organ transplant. 4. Severe pulmonary disease (FEV1 \< 50 % predicted). 5. Significant cardiac or atherosclerotic disease with planned re-vascularization within 12 months. 6. ASA class IV or V uncompensated cardiopulmonary disease. 7. Left-ventricular ejection fraction \< 25 % or MI/unstable angina/stroke/heart surgery/coronary stent within 6 months. 8. Hiatal hernia \> 7 cm or LA grade C/D erosive esophagitis. 9. Active Crohn's disease. 10. Severe psychiatric illness, dementia, active psychosis, history of suicide attempt, or alcohol/substance abuse within 12 months. 11. Pregnant, breastfeeding, planning pregnancy, or not using adequate contraception. 12. Malignancy within the prior 12 months (except non-melanoma skin cancer). 13. Life expectancy \< 2 years in investigator's judgment. 14. Investigational therapy within 3 months. 15. Acute pancreatitis ≤ 90 days. 16. Portal vein thrombosis at screening. 17. Decompensated cirrhosis (moderate/large ascites, hepatic encephalopathy, or listed for liver transplant); small ascites or prior variceal bleed allowed. 18. Total bilirubin \> 3 mg/dL, INR \> 1.7, or platelets \< 50 000/µL (within 1 month). 19. Significant alcohol intake (\> 14 units/week women, \> 21 units/week men) within the prior 12 months. 20. eGFR \< 45 mL/min/1.73 m² or on dialysis (within 1 month). 21. AIDS. 22. Unable to understand study or give consent. 23. Plans to move more than 3 hours from Cleveland within 6 months. 24. Previous randomization in this trial. 25. Any condition that, in the investigator's opinion, places the subject at undue risk.