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Routine Versus Selective Liver Biopsy During Bariatric Surgery: Postoperative Outcomes and Preoperative Predictors of
Joshua Tseng1,2, Jeremy Korman3,4, Mazen Noureddin5
1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
Obesity Surgery
|November 24, 2021
Summary
Routine liver biopsies during bariatric surgery detect more nonalcoholic steatohepatitis (NASH) than selective biopsies. This approach is safe, with no increased postoperative complications for patients with obesity.
Area of Science:
- Hepatology
- Bariatric Surgery
- Obesity Medicine
Background:
- Nonalcoholic steatohepatitis (NASH) is prevalent in individuals with obesity.
- Liver biopsy (LB) during bariatric surgery can identify NASH.
- Routine versus selective LB strategies require evaluation.
Purpose of the Study:
- Compare NASH detection rates between routine and selective liver biopsies during bariatric surgery.
- Assess the safety of routine liver biopsies regarding postoperative outcomes.
- Identify predictors of NASH in patients undergoing bariatric surgery.
Main Methods:
- Retrospective chart review of patients undergoing bariatric surgery (2016-2020).
- Comparison of LB results between routine and selective biopsy groups.
- Analysis of postoperative outcomes for patients with and without LB.
- Multivariable regression to determine NASH predictors.
Main Results:
- Routine LB (330) identified significantly higher rates of steatosis, inflammation, fibrosis, and NASH compared to selective LB (70).
- No significant differences in postoperative complications, transfusions, readmissions, or reoperations between LB and non-LB groups.
- Higher BMI (>40) and insulin-dependent diabetes predicted higher NASH odds; Black race predicted lower odds.
Conclusions:
- Routine liver biopsies during bariatric surgery are more effective in identifying advanced nonalcoholic fatty liver disease (NAFLD) than selective biopsies.
- Routine liver biopsies can be safely performed without increasing postoperative complications.
- Predictors of NASH include high BMI, diabetes, and race.
