The Use of Transient Elastography Technology in the Bariatric Patient: a Review of the Literature
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REVIEW
The Use of Transient Elastography Technology in the Bariatric Patient: a Review of the Literature Max M. Puthenpura 1
&
Vishal Patel 2 & John Fam 1,3 & Leon Katz 1,3 & David S. Tichansky 1,3 & Stephan Myers 1,3
Received: 1 August 2020 / Revised: 17 September 2020 / Accepted: 22 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Transient elastography (TE) is a non-invasive technology that demonstrates promise in assessing liver steatosis and fibrosis without the risks of traditional percutaneous liver biopsy. Many studies have examined its reliability in respect to liver biopsy, but fewer have examined using TE in obese and bariatric surgery patients. With evidence showing that bariatric surgery can lead to improvement of liver steatosis and fibrosis, TE has the potential to provide a simple avenue of hepatic assessment in patients before and after procedures. This review article investigates what is known about the reliability of TE and its implementation in obese and bariatric surgery patients. Keywords Transient elastography . Liver . Steatosis . Fibrosis . Bariatric surgery . Obesity
Introduction Obesity is a worldwide epidemic, with an estimated 5% of children and 12% of adults in 2015 meeting criteria for obesity [1]. In the USA, 42.4% of adult Americans have a BMI (Body Mass Index) of 30 or greater which meets criteria for obesity with an almost equal proportion of men and women afflicted [2]. Obesity is frequently associated with fatty liver disease that may lead to fibrosis or a diagnosis of cirrhosis [3]. In fact, with the increasing availability of treatment for hepatitis C, obesity is now the most frequent cause of liver disease leading to liver transplant [4]. Determining the severity of fatty liver disease and the degree of fibrosis is important for the health of the patient and assists the transplant hepatologist and bariatric surgeon in evaluating the patient as a possible surgery candidate. It is estimated that 30–40% of US adults have nonalcoholic fatty liver disease (NAFLD) and 3–12% of the
* Max M. Puthenpura [email protected] 1
Department of Surgery, Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA 19129, USA
2
The Center for Liver Disease, Tower Health Transplant Institute, 420 S 5th Ave, West Reading, PA 19611, USA
3
Tower Health Weight Loss Surgery and Wellness Center, 1220 Broadcasting Rd, Wyomissing, PA 19610, USA
adults currently have non-alcoholic steatohepatitis (NASH) [5]. Traditionally, the invasive technique of liver biopsy has been the gold standard for diagnosis of the severity of liver disease. A non-invasive technique called transient elastography (TE) has demonstrated promising results in assessing fatty liver disease and fibrosis, with one of the most predominant technologies being branded as Fibroscan. The complex relationship between obesity, liver steatosis, and liver fibrosis demonstrates the lasting effects of metabolic disease on patients as well as the importance of monitoring liver p
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