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

Agarwal, Lokesh; Aggarwal, Sandeep; Shalimar, S.; Yadav, Rajni; Dattagupta, S; Garg, Harshit; Agarwal, Samagra

doi:10.1007/s11695-020-04977-4

Cited by 31 publications

(24 citation statements)

References 30 publications

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“…Despite this, we were able to show substantial and important improvements in NAFLD in the majority. Our follow-up time of 12 months provides short to medium term data in line with other recent studies 18 . Longer-term data showing the impact of bariatric surgery on NAFLD/NASH beyond 12 months will be important to guide the use of this treatment modality.…”

Section: Discussionsupporting

confidence: 90%

“…Using the Fibroscan XL probe and an experienced operator we had a high success rate of 88% at baseline pre-op and 100% at follow-up, even with mean BMI in these groups being 40.2 and 28.7, respectively. A number of recent reports using the XL probe have shown similar high success rates [15][16][17][18] confirming the utility of transient elastography even in extreme obesity. Fibroscan failure is almost always caused by excess subcutaneous fat overlying the right chest wall which increases the skin to liver capsule distance 10,19 .…”

Section: Discussionmentioning

confidence: 74%

“…The role of bariatric surgery in modulating the disease trajectory of NAFLD is less well established with limited numbers of reports showing improved disease markers or histology 22,23 . A recent trial involving paired liver biopsies and fibroscan pre and one-year post surgery provided positive results but with some cautions 18 . In the 58 patients studied, all histological parameters were improved on average, with reversal of cirrhosis in two of three effected patients and resolution of NASH in one third.…”

Section: Discussionmentioning

confidence: 99%

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Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

Yang

Nguyen

et al. 2021

Sci Rep

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Significant weight loss can modify the progression of Nonalcoholic fatty liver disease (NAFLD) with the most convincing evidence coming from bariatric surgery cohorts. Effective ways to non-invasively characterise NAFLD in these patients has been lacking, with high Fibroscan failure rates reported. We prospectively evaluated the utility of Fibroscan using XL-probe over a two-year period. 190 consecutive patients undergoing bariatric surgery were followed as part of their routine care. All patients had Fibroscan performed on the day of surgery and at follow-up a mean of 13 months (± 6.3) later. The majority of patients were female (82%) with mean age of 42. Fibroscan was successful in 167 (88%) at baseline and 100% at follow up. Patients with a failed Fibroscan had higher body mass index (BMI) and alanine transaminase (ALT), but no difference in FIB-4/NAFLD score. Mean baseline Liver stiffness measurement was 5.1 kPa, with 87% of patients classified as no fibrosis and 4% as advanced fibrosis. Mean baseline controlled attenuation parameter was 291, with 78% having significant steatosis, 56% of which was moderate-severe. Significant fibrosis was associated with higher BMI and HbA1c. Significant steatosis was associated with higher BMI, ALT, triglycerides and insulin resistance. Mean follow up time was 12 months with weight loss of 25.7% and BMI reduction of 10.4 kg/m2. Seventy patients had repeat fibroscan with reductions in steatosis seen in 90% and fibrosis in 67%. Sixty-four percent had complete resolution of steatosis. Fibroscan can be performed reliably in bariatric cohorts and is useful at baseline and follow-up. Significant steatosis, but not fibrosis was seen in this cohort with substantial improvements post-surgery.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

Yang

Nguyen

et al. 2021

Sci Rep

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“…Lifestyle interventions are the primary modality for the management of NAFLD and have been shown to improve biochemical and histological outcomes in Indian patients 1 . A study with paired liver biopsies in 58 morbidly obese patients showed improvement in all histological parameters of NAFLD, including steatosis, ballooning, lobular inflammation, NAFLD Activity Score, and fibrosis, at 1‐year follow‐up after bariatric surgery 19 . Of various endoscopic bariatric therapies, only a small amount of data for eight patients described the utility of intragastric balloon for inducing weight loss in morbidly obese patients with cirrhosis (4‐cryptogenic cirrhosis) on the transplant wait list 20 .…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…1 A study with paired liver biopsies in 58 morbidly obese patients showed improvement in all histological parameters of NAFLD, including steatosis, ballooning, lobular inflammation, NAFLD Activity Score, and fibrosis, at 1year follow-up after bariatric surgery. 19 Of various endoscopic bariatric therapies, only a small amount of data for eight patients described the utility of intragastric balloon for inducing weight loss in morbidly obese patients with An Official Learning Resource of AASLD Indian Perspective of NAFLD De and Duseja review cirrhosis (4-cryptogenic cirrhosis) on the transplant wait list. 20 Pharmacotherapy in patients with NASH was earlier restricted to the use of vitamin E and pioglitazone.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%