Applicability and Results of Liver Stiffness Measurement and Controlled Attenuation Parameter Using XL Probe for Metabol
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ORIGINAL CONTRIBUTIONS
Applicability and Results of Liver Stiffness Measurement and Controlled Attenuation Parameter Using XL Probe for Metabolic-Associated Fatty Liver Disease in Candidates to Bariatric Surgery. A Single-Center Observational Study Tao Wan 1,2,3 & Nastassja Köhn 1 & Dino Kröll 1 & Annalisa Berzigotti 1,2 Received: 16 May 2020 / Revised: 6 September 2020 / Accepted: 10 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Patients with morbid obesity are at high risk of liver fibrosis due to metabolic-associated fatty liver disease. Data on liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) by vibration-controlled transient elastography (VCTE, FibroScan®) XL probe for liver fibrosis and steatosis assessment in morbid obesity are needed. Materials and Methods LSM and CAP were measured in candidates to bariatric surgery at a single center during 12 months. In patients who underwent an intraoperative liver biopsy, we compared LSM and CAP with histology findings. Comorbidities, body mass index, type of surgery, and infections after surgery were collected and analyzed. Results Of the eighty-three patients assessed by XL probe, 49 (59%; female in 63%, BMI 42.6 ± 5.1 kg/m2) had a valid LSM and CAP measurement. LSM was 7.0 ± 3.9 kPa and CAP 329 ± 57 dB/m. In the 14 patients undergoing intraoperative liver biopsy, all had steatosis (severe in 50%), 6 (43%) had NASH (NAS ≥ 5), and 4 (29%) showed significant or bridging fibrosis. LSM accurately discriminated between patients with and without significant or severe fibrosis (AUROC 0.833) and CAP wellidentified patients with or without ≥S2 steatosis (AUROC 0.896). Nine of 49 patients (18%) tested positive for significant/ severe fibrosis by LSM (cut-off 8.9 kPa). Conclusion Applicability of LSM and CAP by XL probe in patients candidate to bariatric surgery was moderate. However, when technically successful, their reliability to diagnose severe steatosis and fibrosis related to MAFLD was good. Keywords Non-invasive . Cirrhosis . Liver fibrosis . Liver steatosis . Sleeve gastrectomy . Laparoscopic Roux-en-Y gastric bypass
Introduction The increasing prevalence of morbid obesity is a growing problem worldwide, leading to a huge medical, economic, Tao Wan is supported by a scholarship by the China Scholarship Council (CSC). * Annalisa Berzigotti [email protected] 1
Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
2
Department of Biomedical Research, University of Bern, Bern, Switzerland
3
Department of Hepatobiliary Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
and social impact [1]. Morbidly obese patients often have metabolic syndrome [2], and non-alcoholic fatty liver disease (NAFLD), recently renamed as metabolic-associated fatty liver disease (MAFLD) [3], is highly prevalent in this population [4, 5], ranging 70–90% [6], and it is increasingly prevalent
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