An Argument for Routinely Performing Liver Biopsy with Bariatric Procedures (original) (raw)
Related papers
Surgery for Obesity and Related Diseases, 2009
Background: Nonalcoholic fatty liver disease is associated with morbid obesity. Liver biopsy is the reference standard for the diagnosis of nonalcoholic fatty liver disease. It is unclear whether the macroscopic liver appearance correlates with the histopathologic findings. Our objective was to determine the relationship between the intraoperative liver appearance and the histopathologic findings during laparoscopic bariatric surgery at a tertiary medical center. Methods: Data were prospectively collected from 108 consecutive patients undergoing laparoscopic bariatric surgery with routine intraoperative liver biopsy. An intraoperative liver visual score was recorded according to the size, tan-speckling, and contour. The liver histologic findings were categorized into 3 groups: (1) normal; (2) bland steatosis; and (3) nonalcoholic steatohepatitis (NASH). The liver visual score was compared with the liver histologic findings. A recorded video of the liver was regraded at a later date to determine observer agreement. Results: The prevalence of NASH was 23% (n ϭ 25). Of the 108 patients, 48% with NASH had normal-appearing livers and accounted for 24% (n ϭ 12) of the 50 normal-appearing livers. A similar proportion of NASH cases was found in all 3 visual categories. Furthermore, no relationship was found between the number of abnormal visual cues and the liver histologic findings (P ϭ .23). No complications were directly attributable to liver biopsy. The values for intraobserver and interobserver agreement ranged from fair to almost perfect. Conclusion: NASH is common in the morbidly obese population. There does not appear to be a relationship between liver appearance and the histopathologic findings. Intraoperative liver biopsy is a safe and accurate method of diagnosing liver disease and should be considered in all morbidly obese patients undergoing abdominal surgery. (Surg Obes Relat Dis 2009;5:323-328.)
To perform or not to perform liver biopsy: an alternative view
Gut, 2003
I would like to thank Joy and Scott for their comments in their letter in response to my review (Gut 2002;51:9-10). 1 I entirely agree with their view that ultrasound is highly specific and sensitive for the diagnosis of fatty liver. However, I do not feel that the presence or absence of fatty liver is the issue here. It is established that approximately 30% of patients with fatty liver who have significant fibrosis will go on to develop chronic liver disease and cirrhosis, with all its complications, including hepatoma. 2 The purpose of histological sampling is not to confirm the presence of fatty liver but to see whether fibrosis and other abnormalities are present, putting the patient at risk of developing chronic liver disease. This issue was addressed in a recent article by Saadeh and colleagues 3 who compared patients with non-alcoholic steatohepatitis (NASH) and those with steatosis (nonalcoholic fatty liver disease (NAFLD)) alone. The authors evaluated the role of various radiological modalities, including ultrasound, computed tomography, and magnetic resonance imaging, in the role of distinguishing between NASH and the less aggressive forms of NAFLD. Their conclusion was that none of the radiological modalities detected the presence of hepatocyte ballooning, Mallory's hyaline, or fibrosis, which are the important features in the diagnosis of NASH. The study showed that ultrasound had high sensitivity and specificity for the diagnosis of severe steatosis but it confirmed that ultrasound had no predictive value in the diagnosis of fibrosis or cirrhosis. On the basis of this article together with earlier studies, I can find no basis for the conclusion reached by Joy and Scott that ultrasound is a reasonable alternative to liver biopsy for patients who have abnormal liver function tests with no diagnostic serology.
Intraoperative Liver Biopsy During Adolescent Bariatric Surgery: Is It Really Necessary?
Obesity Surgery, 2019
Background Nonalcoholic fatty liver disease (NAFLD) is prevalent in children with obesity and is definitively diagnosed with liver biopsy. However, the utility of routine biopsy during adolescent bariatric surgery remains unknown. We describe the usefulness of routine versus selective intraoperative liver biopsy in adolescents undergoing bariatric surgery. Methods A retrospective review of adolescents who received bariatric surgery at our institution between 2007 and 2018 was performed. Prior to 2014, all patients routinely received intraoperative liver biopsy. After 2014, biopsy was performed selectively on an individual basis for transaminitis or clinical concern. Demographic, biochemical, and histopathologic data were compared between patients who underwent routine, selective, or no biopsy. Results There were 77 patients who received bariatric surgery during the study period: 32 underwent routine biopsy, 13 selective biopsy, and 32 no biopsy. Selective liver biopsy was more likely to show pathologic evidence of fibrosis (84.6% versus 31.2%, p = 0.000) and steatosis (100.0% versus 59.4%, p = 0.003), and higher mean NAFLD activity score compared with routine biopsies (4.4 versus 2.1, p = 0.001). Patients with steatosis had significantly higher preoperative fasting insulin (41.4 versus 21.1 mIU/L, p = 0.000), and patients with fibrosis had significantly higher glycated hemoglobin (6.1% versus 5.5%, p = 0.033) and alanine aminotransferase (81.5 versus 52.7 mg/dL, p = 0.043). There were no biopsy complications or changes in management due to biopsy results. Conclusions Routine intraoperative liver biopsy during adolescent bariatric surgery possesses questionable benefit, as it does not appear to impact short-term postoperative management. Prospective, longitudinal studies are needed to better understand the meaningfulness of liver histopathology in this population.
Liver biopsy: Analysis of results of two specialist teams
World journal of gastrointestinal pathophysiology, 2014
To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenterologist (G) and interventional radiologist (IR) teams. Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to 31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease, both in the setting of day hospital and regular admission (RA) care, were retrieved and the data entered in a database. Patients were divided into two groups: one undergoing an ultrasonography (US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team. For the first group, an intercostal approach (US-assisted) and a Menghini modified type needle 16 G (length 90 mm) were used. The IR team used a subcostal approach (US-guided) and a semiautomatic modified Menghini type needle 18 G (length 150 mm). All the biopsies were evaluated for appropriateness according to the current guidelines. The number of portal tracts present in each biopsy wa...
Liver biopsy for histological assessment: The case in favor
Saudi Journal of Gastroenterology, 2010
Liver biopsy (LB) is the gold standard method for assessment of liver histology. It provides valuable, otherwise unobtainable information, regarding the degree of fi brosis, parenchymal integrity, degree and pattern of infl ammation, bile duct status and deposition of materials and minerals in the liver. This information provides immense help in the diagnosis and prognostication of a variety of liver diseases. With careful selection of patients, and performance of the procedure appropriately, the complications become exceptionally rare in current clinical practice. Furthermore, the limitations of sampling error and inter-/ intra-observer variability may be avoided by obtaining adequate tissue specimen and having it reviewed by an experienced liver pathologist. Current noninvasive tools are unqualifi ed to replace LB in clinical practice in the face of specifi c limitations for each tool, compounded by a poorer performance towards the assessment of the degree of liver fi brosis, particularly for intermediate stages.