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Obesity Surgery
Erschienen in:

27.02.2024 | Original Contributions

Compare the Combined Diagnostic Accuracy of Transient Elastography and Visual Liver Score in Assessing Non-Alcoholic Fatty Liver Disease (NAFLD) and Compare it with Liver Biopsy in Morbidly Obese Patients Undergoing Bariatric Surgery: An Observational Study

verfasst von: Deborshi Sharma, Gautam Anand, Sanjay Meena, Vaishali Bhardwaj

Erschienen in: Obesity Surgery | Ausgabe 4/2024

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Abstract

Introduction

A liver biopsy is the gold standard for the diagnosis of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Here, we combine preoperative transient elastography (TE) and intraoperative standardized visual liver score (VLS) which is compared with intraoperative liver biopsy for prediction of NAFLD and NASH in patients undergoing bariatric surgery.

Aim

Evaluate the combined diagnostic accuracy of TE and VLS in assessing NAFLD or NASH and compare it with liver biopsy in patients undergoing bariatric surgery.

Methods

In a prospective cohort of 70 morbidly obese undergoing bariatric surgery, preoperative TE and intraoperative VLS were calculated. Findings of TE and VLS were compared with histology from intraoperative liver biopsy.

Results

Histologically, 44 (62.85%) had NAFLD (≥ S1). Significant steatosis was seen in 20 (28.57%) while significant fibrosis was visible in 18 (25.71%). Area Under the Receiver Operating Characteristics (AUROC) TE for diagnosis of NAFLD was excellent (0.844, p = 0.001). At the optimal cutoff of 8.1, the positive predictive value (PPV) was 92.9%, and diagnostic accuracy was 90.6%. VLS had a sensitivity of 90.9% for NAFLD. The combined sensitivity of TE + VLS was 95.5% for ruling out NAFLD. Fourteen (20%) had NASH. VLS had a diagnostic accuracy of 97% in identifying NASH in comparison to TE. AUROC-VLS was 0.987, p ≤ 0.001, and a sensitivity of 100%. The overall sensitivity of combined TE and VLS was 100% with a negative predictive value (NPV) of 100%.

Conclusion

TE when combined with intraoperative VLS is comparable to liver biopsy and can be used for the diagnosis of NAFLD and NASH in patients undergoing bariatric surgery.

Graphical Abstract

Literatur
1.
Angulo P. GI epidemiology: nonalcoholic fatty liver disease. Aliment Pharmacol Ther. 2007;25:883–9.CrossRefPubMed
2.
Yatsuji S, Hashimoto E, Tobari M, et al. Clinical features and outcomes of cirrhosis due to non-alcoholic steatohepatitis compared with cirrhosis caused by chronic hepatitis C. J Gastroenterol Hepatol. 2009;24:248–54.CrossRefPubMed
3.
Mahawar KK, Parmar C, Graham Y, et al. Routine liver biopsy during bariatric surgery: an analysis of evidence base. Obes Surg. 2016;26:177–81.CrossRefPubMed
4.
Rockey DC, Caldwell SH, Goodman ZD, et al. Liver biopsy. Hepatol Baltim Md. 2009;49:1017–44.CrossRef
5.
Ratziu V, Charlotte F, Heurtier A, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898–906.CrossRefPubMed
6.
Singh S, Muir AJ, Dieterich DT, et al. American gastroenterological association institute technical review on the role of elastography in chronic liver diseases. Gastroenterology. 2017;152:1544–77.CrossRefPubMed
7.
Wong VW-S, Vergniol J, Wong GL-H, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatol Baltim Md. 2010;51:454–62.CrossRef
8.
Garg H, Aggarwal S, Shalimar, et al. Utility of transient elastography (fibroscan) and impact of bariatric surgery on nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2018;14:81–91.CrossRef
9.
Myers RP, Pomier-Layrargues G, Kirsch R, et al. Feasibility and diagnostic performance of the FibroScan XL probe for liver stiffness measurement in overweight and obese patients. Hepatol Baltim Md. 2012;55:199–208.CrossRef
10.
Dolce CJ, Russo M, Keller JE, et al. Does liver appearance predict histopathologic findings: prospective analysis of routine liver biopsies during bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2009;5:323–8.CrossRef
11.
Ooi GJ, Burton PR, Earnest A, et al. Visual liver score to stratify non-alcoholic steatohepatitis risk and determine selective intraoperative liver biopsy in obesity. Obes Surg. 2018;28:427–36.CrossRefPubMed
12.
Brunt EM, Kleiner DE, Wilson LA, et al. Nonalcoholic fatty liver disease (NAFLD) activity score and the histopathologic diagnosis in NAFLD: distinct clinicopathologic meanings. Hepatol Baltim Md. 2011;53:810–20.CrossRef
13.
Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatol Baltim Md. 2005;41:1313–21.CrossRef
14.
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9.CrossRef
15.
Jones RE, Yeh AM, Kambham N, et al. Intraoperative liver biopsy during adolescent bariatric surgery: is it really necessary? Obes Surg. 2020;30:69–76.CrossRefPubMed
16.
Teixeira ARF, Bellodi-Privato M, Carvalheira JB, et al. The incapacity of the surgeon to identify NASH in bariatric surgery makes biopsy mandatory. Obes Surg. 2009;19:1678–84.CrossRefPubMed
17.
Collins H, Beban G, Windsor J, et al. Safety and utility of liver biopsy during bariatric surgery in the New Zealand setting. Obes Surg. 2020;30:313–8.CrossRefPubMed
18.
Sjöström L. Review of the key results from the Swedish obese subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.CrossRefPubMed
19.
Agarwal L, Aggarwal S, Shalimar, et al. Bariatric surgery in nonalcoholic fatty liver disease (NAFLD): impact assessment using paired liver biopsy and fibroscan. Obes Surg. 2021;31:617–26.CrossRefPubMed
20.
Ooi GJ, Earnest A, Kemp WW, et al. Brown WA (2018) Evaluating feasibility and accuracy of non-invasive tests for nonalcoholic fatty liver disease in severe and morbid obesity. Int J Obes. 2005;42:1900–11.CrossRef
21.
MilovanovicAlempijevic T, StojkovicLalosevic M, Dumic I, et al. Diagnostic accuracy of platelet count and platelet indices in noninvasive assessment of fibrosis in nonalcoholic fatty liver disease patients. Can J Gastroenterol Hepatol. 2017;2017:6070135.CrossRef
22.
Nickel F, Tapking C, Benner L, et al. Bariatric surgery as an efficient treatment for non-alcoholic fatty liver disease in a prospective study with 1-year follow-up: BariScan study. Obes Surg. 2018;28:1342–50.CrossRefPubMed
23.
Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149:389-397.e10.CrossRefPubMed
24.
Naveau S, Lamouri K, Pourcher G, et al. The diagnostic accuracy of transient elastography for the diagnosis of liver fibrosis in bariatric surgery candidates with suspected NAFLD. Obes Surg. 2014;24:1693–701.CrossRefPubMed
25.
Ekstedt M, Hagström H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatol Baltim Md. 2015;61:1547–54.CrossRef
26.
Karcz WK, Krawczykowski D, Kuesters S, et al. Influence of sleeve gastrectomy on NASH and type 2 diabetes mellitus. J Obes. 2011;2011: 765473.CrossRefPubMed
27.
Dyson JK, Anstee QM, McPherson S. Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging. Frontline Gastroenterol. 2014;5:211–8.
28.
de Carli MA, de Carli LA, Correa MB, et al. Performance of noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol. 2020;32:420–5.
29.
Jan A, Narwaria M, Mahawar KK. A systematic review of bariatric surgery in patients with liver cirrhosis. Obes Surg. 2015;25:1518–26.
Metadaten
Titel
Compare the Combined Diagnostic Accuracy of Transient Elastography and Visual Liver Score in Assessing Non-Alcoholic Fatty Liver Disease (NAFLD) and Compare it with Liver Biopsy in Morbidly Obese Patients Undergoing Bariatric Surgery: An Observational Study
verfasst von
Deborshi Sharma
Gautam Anand
Sanjay Meena
Vaishali Bhardwaj
Publikationsdatum
27.02.2024
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 4/2024
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-024-07106-7

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