Bariatric Surgery in Nonalcoholic Fatty Liver Disease (NAFLD): Impact Assessment Using Paired Liver Biopsy and Fibroscan

Background Bariatric surgery is associated with a positive impact on the degree of hepatic steatosis and inflammation in nonalcoholic associated fatty liver disease (NAFLD), although its effect on fibrosis is contentious. The role of Fibroscan in the post-bariatric assessment of hepatic steatosis an...

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Published in:Obesity surgery Vol. 31; no. 2; pp. 617 - 626
Main Authors: Agarwal, Lokesh, Aggarwal, Sandeep, Shalimar, Yadav, Rajni, Dattagupta, Siddhartha, Garg, Harshit, Agarwal, Samagra
Format: Journal Article
Language:English
Published: New York Springer US 01.02.2021
Springer Nature B.V
Subjects:
Adult
Bariatric Surgery
Biopsy
Elasticity Imaging Techniques
Fatty liver
Female
Fish oils
Gastrointestinal surgery
Humans
Liver - diagnostic imaging
Liver - pathology
Liver Cirrhosis - pathology
Liver diseases
Male
Medicine
Medicine & Public Health
Non-alcoholic Fatty Liver Disease - diagnostic imaging
Non-alcoholic Fatty Liver Disease - pathology
Obesity, Morbid - surgery
Original Contributions
Prospective Studies
Surgery
Liver biopsy
Obesity
NAFLD
Bariatric surgery
Fibroscan
Nonalcoholic steatohepatitis (NASH)
ISSN:0960-8923, 1708-0428, 1708-0428
Online Access:Get full text
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Summary:Background Bariatric surgery is associated with a positive impact on the degree of hepatic steatosis and inflammation in nonalcoholic associated fatty liver disease (NAFLD), although its effect on fibrosis is contentious. The role of Fibroscan in the post-bariatric assessment of hepatic steatosis and fibrosis is unclear. Objectives This work aims to study the impact of bariatric surgery on the course of NAFLD using both invasive (liver biopsy) and non-invasive tests (biochemical parameters and Fibroscan). Methods In this prospective study, the impact of bariatric surgery on the course of NAFLD was assessed using paired liver biopsy (intra-operative and post-bariatric surgery 1-year follow-up). The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) cutoffs for the assessment of hepatic fibrosis and steatosis, respectively, were calculated in both pre- and post-bariatric settings. Results Fifty-eight patients (70.7% females, mean age 39.2 years) underwent paired liver biopsy. Post-bariatric surgery 1-year liver biopsy showed significant improvement in all the histopathological parameters of NAFLD. The mean NAFLD Activity Score declined from 2.81 (± 1.08) to 1.31 (± 1.39) post-bariatric surgery. Thirty (51.7%) patients showed improvement in fibrosis, eighteen (31%) no change, and ten (17.2%) had worsening. Worsening of fibrosis was associated with a higher median age of 44.5 versus 38 years ( p value = 0.033). The CAP cutoff values for the various stages of hepatic steatosis were higher pre-operatively as compared with those obtained post-bariatric surgery. Conclusions Bariatric surgery is associated with significant improvement in histopathological parameters of NAFLD. Fibroscan shows good diagnostic accuracy in detecting advanced stage and grade of NAFLD.
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ISSN:0960-8923
1708-0428
1708-0428
DOI:10.1007/s11695-020-04977-4