Bariatric Surgery in Nonalcoholic Fatty Liver Disease (NAFLD): Impact Assessment Using Paired Liver Biopsy and Fibroscan
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ORIGINAL CONTRIBUTIONS
Bariatric Surgery in Nonalcoholic Fatty Liver Disease (NAFLD): Impact Assessment Using Paired Liver Biopsy and Fibroscan Lokesh Agarwal 1 & Sandeep Aggarwal 1 Samagra Agarwal 4
&
Shalimar 2 & Rajni Yadav 3 & Siddhartha Dattagupta 3 & Harshit Garg 1 &
Received: 28 June 2020 / Revised: 5 September 2020 / Accepted: 11 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Bariatric surgery is associated with a positive impact on the degree of hepatic steatosis and inflammation in nonalcoholic associated fatty liver disease (NAFLD), although its effect on fibrosis is contentious. The role of Fibroscan in the post-bariatric assessment of hepatic steatosis and fibrosis is unclear. Objectives This work aims to study the impact of bariatric surgery on the course of NAFLD using both invasive (liver biopsy) and non-invasive tests (biochemical parameters and Fibroscan). Methods In this prospective study, the impact of bariatric surgery on the course of NAFLD was assessed using paired liver biopsy (intra-operative and post-bariatric surgery 1-year follow-up). The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) cutoffs for the assessment of hepatic fibrosis and steatosis, respectively, were calculated in both pre- and post-bariatric settings. Results Fifty-eight patients (70.7% females, mean age 39.2 years) underwent paired liver biopsy. Post-bariatric surgery 1-year liver biopsy showed significant improvement in all the histopathological parameters of NAFLD. The mean NAFLD Activity Score declined from 2.81 (± 1.08) to 1.31 (± 1.39) post-bariatric surgery. Thirty (51.7%) patients showed improvement in fibrosis, eighteen (31%) no change, and ten (17.2%) had worsening. Worsening of fibrosis was associated with a higher median age of 44.5 versus 38 years (p value = 0.033). The CAP cutoff values for the various stages of hepatic steatosis were higher preoperatively as compared with those obtained post-bariatric surgery. Conclusions Bariatric surgery is associated with significant improvement in histopathological parameters of NAFLD. Fibroscan shows good diagnostic accuracy in detecting advanced stage and grade of NAFLD. Keywords NAFLD . Nonalcoholic steatohepatitis (NASH) . Bariatric surgery . Liver biopsy . Fibroscan . Obesity
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04977-4) contains supplementary material, which is available to authorized users. * Sandeep Aggarwal [email protected] Lokesh Agarwal [email protected] Shalimar [email protected]
Samagra Agarwal [email protected] 1
Departments of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
2
Departments of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences (AIIMS), New Delhi, India
3
Departments of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
4
Departments of Internal Medi
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