Utility of transient elastography (fibroscan) and impact of bariatric surgery on nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients

Garg, Harshit; Aggarwal, Sandeep; Shalimar, S.; Yadav, Rajni; Gupta, Siddhartha Datta; Agarwal, Lokesh; Agarwal, Samagra

doi:10.1016/j.soard.2017.09.005

Cited by 94 publications

(67 citation statements)

References 29 publications

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“…Thus, dapagliflozin may contribute to improvement of hepatic steatosis in patients with type 2 diabetes and NAFLD by inhibiting fatty acid production through promotion of urinary glucose excretion. However, a very recent study has investigated the impact of bariatric surgery‐induced weight loss on NAFLD by FibroScan in morbidly obese subjects, showing a significant improvement in CAP and LSM . The possibility cannot be excluded, therefore, that CAP or LSM reduction by dapagliflozin may be associated with a reduction in body weight or VAT.…”

Section: Discussionmentioning

confidence: 82%

“…However, a very recent study has investigated the impact of bariatric surgery-induced weight loss on NAFLD by FibroScan in morbidly obese subjects, showing a significant improvement in CAP and LSM. 30 The possibility cannot be excluded, therefore, that CAP or LSM reduction by dapagliflozin may be associated with a reduction in body weight or VAT. Nevertheless, as we found a significant positive correlation between change in CAP and change in HbA1c in the dapagliflozin group, the reduction in CAP may be attributable to an improvement in glycaemic control.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the effects of dapagliflozin, a sodium‐glucose co‐transporter‐2 inhibitor, on hepatic steatosis and fibrosis using transient elastography in patients with type 2 diabetes and non‐alcoholic fatty liver disease

Shimizu

Suzuki²,

Kato

et al. 2018

Diabetes Obesity Metabolism

281

219

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Based on these findings, the sodium-glucose co-transporter-2 inhibitor dapagliflozin improves liver steatosis in patients with type 2 diabetes and NAFLD, and attenuates liver fibrosis only in patients with significant liver fibrosis, although the possibility cannot be excluded that a reduction in body weight or visceral adipose tissue by dapagliflozin may be associated with a decrease of liver steatosis or fibrosis.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Evaluation of the effects of dapagliflozin, a sodium‐glucose co‐transporter‐2 inhibitor, on hepatic steatosis and fibrosis using transient elastography in patients with type 2 diabetes and non‐alcoholic fatty liver disease

Shimizu

Suzuki²,

Kato

et al. 2018

Diabetes Obesity Metabolism

281

219

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“…Previous studies have assessed the role of imaging in longitudinal assessment of steatosis and fibrosis after bariatric surgery. These studies have shown improvement in liver stiffness measurement and steatosis by Fibroscan, and correlations between the decrease in hepatic steatosis and the fat fraction measured by MRI . However, no study has been able to demonstrate correlations between imaging parameters and improvement in NASH and disease severity after bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

Multiparametric Magnetic Resonance Elastography Improves the Detection of NASH Regression Following Bariatric Surgery

Allen¹,

Shah²,

Therneau³

et al. 2019

Hepatol Commun

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Disease monitoring in nonalcoholic steatohepatitis (NASH) is limited by absence of noninvasive biomarkers of disease regression or progression.We aimed to examine the role of multiparametric three-dimensional magnetic resonance elastography (3D-MRE) and magnetic resonance imaging proton density fat fraction (MRI-PDFF) in the detection of NASH regression after interventions. This is a single-center prospective clinical trial of 40 patients who underwent bariatric surgery. Imaging and liver biopsies were obtained at baseline and 1 year after surgery. The imaging protocol consisted of multifrequency 3D-MRE to determine the shear stiffness at 60 Hz and damping ratio at 40 Hz, and MRI-PDFF to measure the fat fraction. A logistic regression model including these three parameters was previously found to correlate with NASH. We assessed the model performance in the detection of NASH resolution after surgery by comparing the image-predicted change in NAFLD activity score (delta NAS) to the histologic changes. A total of 38 patients (median age 43, 87% female, 30 of 38 with NAS ≥ 1, and 13 of 38 with NASH) had complete data at 1 year. The NAS decreased in all subjects with NAS ≥ 1 at index biopsy, and NASH resolved in all 13. There was a strong correlation between the predicted delta NAS by imaging and the delta NAS by histology (r = 0.73, P < 0.001). The strength of correlation between histology and the predicted delta NAS using single conventional parameters, such as the fat fraction by MRI-PDFF or shear stiffness at 60 Hz by MRE, was r = 0.69 (P < 0.001) and r = 0.43 (P = 0.009), respectively. Conclusion: Multiparametric 3D-MRE and MRI-PDFF can detect histologic changes of NASH resolution after bariatric surgery. Studies in a nonbariatric setting are needed to confirm the performance as a composite noninvasive biomarker for longitudinal NASH monitoring.

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“…46 Table 3 shows studies on the performance of LSM in NAFLD patients compared with liver biopsy. 25,27,[29][30][31][47][48][49][50][51] Overall, the AUROC of LSM for stages F1, F2, F3, and F4 were 0.82, 0.85, 0.94, and 0.96, respectively. For F2-4 fibrosis, the LSM cut-off values range from 6.2 to 11 kPa, with 62-90% sensitivity and 74-100% specificity.…”

Section: Performancementioning

confidence: 94%

“…18 Table 1 summarizes studies comparing the performance of CAP against liver histology for the detection of various steatosis grades. [19][20][21][22][23][24][25][26][27][28][29][30][31] Overall, the areas under receiver-operating characteristics curves (AUROC) are 81-84% for ≥S1 (steatosis in at least 5-10% of hepatocytes), 85-88% for ≥S2 (33%), and 86-91% for S3 (66%) steatosis. The reported sensitivities for ≥S1, ≥S2 and S3 are 60-75%, 69-84% and 77-96%, respectively.…”

Section: Performancementioning

confidence: 99%

Application of transient elastography in nonalcoholic fatty liver disease

Zhang

Wong

2020

Clin Mol Hepatol

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Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Although it has become one of the leading causes of cirrhosis and hepatocellular carcinoma in the Western world, the proportion of NAFLD patients developing these complications is rather small. Therefore, current guidelines recommend noninvasive tests for the initial assessment of NAFLD. Among the available non-invasive tests, transient elastography by FibroScan<sup>®</sup> (Echosens, Paris, France) is commonly used by hepatologists in Europe and Asia, and the machine has been introduced to the United States in 2013 with rapid adoption. Transient elastography measures liver stiffness and the controlled attenuation parameter simultaneously and can serve as a one-stop examination for both liver steatosis and fibrosis. Liver stiffness measurement also correlates with clinical outcomes and can be used to select patients for varices screening. Although obesity is a common reason for measurement failures, the development of the XL probe allows successful measurements in the majority of obese patients. This article reviews the performance and limitations of transient elastography in NAFLD and highlights its clinical applications. We also discuss the reliability criteria for transient elastography examination and factors associated with false-positive liver stiffness measurements.

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Utility of transient elastography (fibroscan) and impact of bariatric surgery on nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients

Cited by 94 publications

References 29 publications

Evaluation of the effects of dapagliflozin, a sodium‐glucose co‐transporter‐2 inhibitor, on hepatic steatosis and fibrosis using transient elastography in patients with type 2 diabetes and non‐alcoholic fatty liver disease

Evaluation of the effects of dapagliflozin, a sodium‐glucose co‐transporter‐2 inhibitor, on hepatic steatosis and fibrosis using transient elastography in patients with type 2 diabetes and non‐alcoholic fatty liver disease

Multiparametric Magnetic Resonance Elastography Improves the Detection of NASH Regression Following Bariatric Surgery

Application of transient elastography in nonalcoholic fatty liver disease

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