Bilobar Hepatic Histological Variability in Obese Individuals Undergoing Bariatric Surgery: an Analysis of Paired Wedge
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LETTER TO THE EDITOR
Bilobar Hepatic Histological Variability in Obese Individuals Undergoing Bariatric Surgery: an Analysis of Paired Wedge Biopsies Pedro H. F. Sousa-Filho 1 & Laísa S. Jimenez 1 & Guilherme H. Callejas 1 & Matheus M. Concon 1 & João G. R. Braga 1 & Rodolfo A. Marques 1 & Felipe D. M. Chaim 1 & Martinho A. Gestic 1 & Murillo P. Utrini 1 & Almino C. Ramos 1 & Elinton A. Chaim 1 & Everton Cazzo 1 Received: 31 August 2020 / Revised: 11 September 2020 / Accepted: 15 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Introduction
Study Population
Despite being the most accurate method and considered the gold standard for the assessment of nonalcoholic fatty liver disease (NAFLD), liver biopsy is not without flaws. Due to the heterogeneity of fatty deposition in the liver, variability or sampling error can occur in up to 30% of cases, with no agreement between different sites submitted to biopsy in the same individuals, generating difficulties in the management of this disease, especially the risk of underestimating its real severity [1]. The present study aims at determining the frequency of occurrence of histopathological variability of bilobar wedge liver biopsies collected in obese individuals undergoing bariatric surgery and at identifying factors that may predict the presence of a greater heterogeneity of the liver parenchyma.
The individuals underwent surgical procedures from July 2017 through December 2019. Data were obtained from medical records and spreadsheets for outpatient care. We included individuals which underwent bariatric surgery indicated according to the National Institutes of Health (NIH) consensus statement (body mass index ≥ 40 kg/m2or ≥ 35 kg/ m2with obesity-related comorbidities, of any gender, aged between 18 and 70 years). Exclusion criteria were past or current history of liver disease of another nature, vulnerable groups, positive serology for viral liver disease, past or current use of alcohol and illicit drugs, and current or recent use of hepatotoxic drugs.From an initial population of 274 individuals, 22 were excluded due to the following reasons: viral liver diseases (N = 6); use of hepatotoxic medication (N = 7); other liver diseases (N = 2); and incomplete data in medical records (N = 7), leaving a study population of 252 individuals. Informed consent was obtained from all participants of this study.
Methods Study Design A cross-sectional analytical study was carried out enrolling individuals undergoing bariatric surgery (open Roux-en-Y gastric bypass) at a tertiary university hospital. The study protocol was evaluated and approved by the local Research Ethics Committee according to the opinion 3.717.600/ Unicamp (Comment #1).
* Everton Cazzo [email protected] 1
Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n; Cidade Universitaria Zeferino Vaz, Campinas, SP CEP 13085-000, Brazil
Variables The biochemical tests analyzed included fasting blood glucose,
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