The Incapacity of the Surgeon to Identify NASH in Bariatric Surgery Makes Biopsy Mandatory

Teixeira, Antônio Roberto Franchi; Bellodi-Privato, Marta; Carvalheira, José Barreto Campello; Pilla, Victor Fernando; Pareja, José Carlos; ́Albuquerque, Luiz Augusto Carneiro D

doi:10.1007/s11695-009-9980-x

Cited by 35 publications

(23 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surgeons' evaluations could not identify NASH individuals. Teixeira et al [17] demonstrated the inability of surgeons to identify NASH by intraoperative liver appearance, ultrasound or lab findings. Routine liver biopsy during bariatric operations is mandatory to differentiate NASH and NAFLD.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Non-Alcoholic Steatohepatitis and Non-Alcoholic Fatty Liver Disease

2010

Dig Dis

105

View full text Add to dashboard Cite

Background: Overweight and obesity are the most significant risk factors for the development of hepatic steatosis, non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver disease (NAFLD) in children and adults. Both have been increasingly implicated in the genesis of hepatic fibrosis and cirrhosis. However, no consensus exists about whether weight reduction may reverse this process. Methods: To assess the effect of obesity surgery on the histological evolution of NASH, diagnosed in 284 morbidly obese patients by routine liver biopsy (‘first’ biopsy) performed during bariatric surgery, we performed a ‘second’ biopsy after 18.6 ± 8.3 months in 116 patients (109 female, 7 male). 68 patients underwent Roux-en-Y gastric bypass, 38 adjustable gastric banding and 16 biliopancreatic diversion with duodenal switch (BPD-DS). The second biopsy was taken during CHE (102) and relaparoscopy for suspected complications and revisional surgeries (12). All primary and secondary surgical procedures were done laparoscopically without intraoperative or postoperative major complications. All comorbidities were recorded pre- und postoperatively. Results: From the first to the second biopsy, BMI decreased from 55.2 ± 8.3 to 30.5 ± 6.6 kg/m², arterial hypertension decreased from 65 to 43%, and type 2 diabetes decreased from 42 to 2%. On the first biopsy, non-alcoholic fatty liver disease (NAFLD) type 3 was observed in 186 patients (65.5%) and type 4 in 82 (28.9%). The second biopsy revealed complete regression of NAFLD in 89 patients (82.8%) and only 16 (13.8%) still had NAFLD type 1 (mild steatosis without inflammation). These two patients with NAFLD type 3 had adjustable gastric banding with insufficient weight loss (EWL <50%) in history. Complete regression of necroinflammatory activity was observed in 108 patients (93.1%). Among the 12 patients presenting fibrosis in the first biopsy, complete remission was observed in 10 and improvement in 2. Two patients with ascites during BPD-DS showed complete remission within 9–15 months. Two continued to show the same degree of fibrosis without evidence of disease activity. No worsening of steatosis, necroinflammatory activity or fibrosis was observed in any of the patients, and none progressed to cirrhosis. Conclusion: Obesity surgery improves steatosis, necroinflammatory activity and hepatic fibrosis in patients with morbid obesity and NASH. The improvement of all obesity-related comorbidities can be confirmed.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Non-Alcoholic Steatohepatitis and Non-Alcoholic Fatty Liver Disease

2010

Dig Dis

105

View full text Add to dashboard Cite

show abstract

“…Up to 20% of NAFLD have positive serologies for antinuclear antibody, antismooth muscle antibody, and/or antimitochondrial antibody [36][37][38] ; therefore, liver biopsy evaluation might be the only means of determining the underlying cause of the disease. Furthermore, surgeons have shown that intraoperative visualization is commonly not correct for the prediction of either steatosis or advanced fibrosis, and thus liver biopsy is currently being recommended in the morbidly obese bariatric population at the time of surgery [39] . The final "pro" of liver biopsy is both confirmation of the diagnosis, as well as evaluation and semiquantitation of necroinflammatory lesions and fibrosis, and evaluation of architectural remodeling.…”

Section: Value Of Liver Biopsy Evaluation In Nonalcoholic Fatty Livermentioning

confidence: 99%

Histopathology of Non-Alcoholic Fatty Liver Disease

Brunt

2009

Clinics in Liver Disease

115

View full text Add to dashboard Cite

Histological analysis of liver biopsies remains a standard against which other methods of assessment for the presence and amount of hepatic injury due to nonalcoholic fatty liver disease (NAFLD) are measured. Histological evaluation remains the sole method of distinguishing steatosis from advanced forms of NAFLD, i.e. nonalcoholic steatohepatitis (NASH) and fibrosis. Included in the lesions of NAFLD are steatosis, lobular and portal inflammation, hepatocyte injury in the forms of ballooning and apoptosis, and fibrosis. However, patterns of these lesions are as distinguishing as the lesions themselves. Liver injury in adults and children due to NAFLD may have different histological patterns. In this review, the rationale for liver biopsy, as well as the histopathological lesions, the microscopically observable patterns of injury, and the differential diagnoses of NAFLD and NASH are discussed.

show abstract

“…36 The measure of insulin sensitivity indices has shown a reduced mean insulin sensitivity in nonobese, non-diabetic young subjects with NASH in association with the different components of the metabolic syndrome.…”

Section: Insulin Resistancementioning

confidence: 99%

Role of bariatric surgery in treatment of non-alcoholic fatty liver disease

Kermansaravi

Ebrahimian

Delbari

et al. 2017

J. contemp. med. sci.

View full text Add to dashboard Cite

The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) is increasing due to increasing of morbid obesity prevalence worldwide. It has been demonstrated that weight loss is the corner stone of NAFLD/NASH treatment. Various options are available for weight loss in obese patients, such as life style modification, pharmacotherapy, endoscopic interventions and bariatric/metabolic surgery. Performing bariatric/meta bolic surgery only for NAFLD/NASH treatment is on debate, but it has been proven that bar iatric surgery is the most durable and effective treatment for weight loss and obesity-related comorbidities.

show abstract

The Incapacity of the Surgeon to Identify NASH in Bariatric Surgery Makes Biopsy Mandatory

Abstract: No predictor of NASH was found. Surgeons' evaluation could not identify NASH individuals. Routine liver biopsy during bariatric operations is mandatory to differentiate NASH and nonalcoholic fatty liver disease.

Cited by 35 publications

References 30 publications

Surgical Treatment of Non-Alcoholic Steatohepatitis and Non-Alcoholic Fatty Liver Disease

Surgical Treatment of Non-Alcoholic Steatohepatitis and Non-Alcoholic Fatty Liver Disease

Histopathology of Non-Alcoholic Fatty Liver Disease

Role of bariatric surgery in treatment of non-alcoholic fatty liver disease

Contact Info

Product

Resources

About