Skip to main content
SpringerLink
Log in

Does a Calculated “NAFLD Fibrosis Score” Reliably Negate the Need for Liver Biopsy in Patients Undergoing Bariatric Surgery?

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) represents the most common cause of chronic liver disease in the USA. Biopsy has been the standard for determining fibrosis but is invasive, costly, and associated with risk. Previous studies report a calculated “NAFLD fibrosis scores” (cNFS) as a means to overcome the need for biopsy. We compared cNFS versus biopsy-pathological scoring for patients undergoing bariatric surgery.

Methods

We retrospectively reviewed patients with available preoperative labs and patient information undergoing Roux-en-Y gastric bypass (RYGBP) surgery at a single institution over a 5.5-year period. Biopsy samples were blind scored by a single hepatopathologist and compared with scores calculated using a previously reported cNFS.

Results

Of the 225 patients that met the inclusion criteria, the mean body mass index was 44.6 ± 5.4 kg/m2 and 85 % were female. Using the cNFS, 39.6 % of patients were categorized into low fibrosis, 52 % indeterminate, and 8.4 % high fibrosis groups. Analysis of fibrosis by pathology scoring demonstrated 2 of 89 (2.2 %) and 7 of 110 (3.4 %) had significant fibrosis in the low and intermediate groups, respectively. Conversely, in the high fibrosis group calculated by cNFS, only 6 of 19 (31.6 %) exhibited significant fibrosis by pathology scoring.

Conclusions

No definitive model for accurately predicting presence of NAFLD and fibrosis currently exits. Furthermore, under no circumstances should a clinical “NAFLD fibrosis score” replace liver biopsy at this time for RYGBP patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–54.

    Article  CAS  PubMed  Google Scholar 

  2. Bedogni G, Miglioli L, Masutti F, et al. Prevalence of and risk factors for nonalcoholic fatty liver disease: the Dionysos nutrition and liver study. Hepatology. 2005;42:44–52.

    Article  PubMed  Google Scholar 

  3. Fan JG, Zhu J, Li XJ, et al. Prevalence of and risk factors for fatty liver in a general population of Shanghai, China. J Hepatol. 2005;43:508–14.

    Article  PubMed  Google Scholar 

  4. Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–95.

    Article  PubMed  Google Scholar 

  5. Pimentel SK, Strobel R, Goncalves CG, et al. Evaluation of the nonalcoholic fat liver disease fibrosis score for patients undergoing bariatric surgery. Arq Gastroenterol. 2010;47:170–3.

    Article  PubMed  Google Scholar 

  6. Dixon JB. Surgical treatment for obesity and its impact on non-alcoholic steatohepatitis. Clin Liver Dis. 2007;11:141–54. ix–x.

    Article  PubMed  Google Scholar 

  7. Ong JP, Elariny H, Collantes R, et al. Predictors of nonalcoholic steatohepatitis and advanced fibrosis in morbidly obese patients. Obes Surg. 2005;15:310–5.

    Article  PubMed  Google Scholar 

  8. Papadia FS, Marinari GM, Camerini G, et al. Liver damage in severely obese patients: a clinical–biochemical–morphologic study on 1,000 liver biopsies. Obes Surg. 2004;14:952–8.

    Article  PubMed  Google Scholar 

  9. Ong JP, Younossi ZM. Epidemiology and natural history of NAFLD and NASH. Clin Liver Dis. 2007;11:1–16. vii.

    Article  PubMed  Google Scholar 

  10. Tsai S, Choti MA, Assumpcao L, et al. Impact of obesity on perioperative outcomes and survival following pancreaticoduodenectomy for pancreatic cancer: a large single-institution study. J Gastrointest Surg. 2010;14:1143–50.

    Article  PubMed  Google Scholar 

  11. Qureshi K, Clements RH, Abrams GA. The utility of the "NAFLD fibrosis score" in morbidly obese subjects with NAFLD. Obes Surg. 2008;18:264–70.

    Article  PubMed  Google Scholar 

  12. Berker D, Koparal S, Isik S, et al. Compatibility of different methods for the measurement of visceral fat in different body mass index strata. Diagn Interv Radiol. 2010;16:99–105.

    PubMed  Google Scholar 

  13. Gholam PM, Kotler DP, Flancbaum LJ. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg. 2002;12:49–51.

    Article  PubMed  Google Scholar 

  14. Sanyal AJ, Banas C, Sargeant C, et al. Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C. Hepatology. 2006;43:682–9.

    Article  PubMed  Google Scholar 

  15. Caldwell SH, Oelsner DH, Iezzoni JC, et al. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology. 1999;29:664–9.

    Article  CAS  PubMed  Google Scholar 

  16. Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123:134–40.

    Article  PubMed  Google Scholar 

  17. Adams LA, Lymp JF, St Sauver J, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129:113–21.

    Article  PubMed  Google Scholar 

  18. Dixon JB, Bhathal PS, O'Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology. 2001;121:91–100.

    Article  CAS  PubMed  Google Scholar 

  19. Tai CM, Huang CK, Hwang JC, et al. Improvement of nonalcoholic fatty liver disease after bariatric surgery in morbidly obese Chinese patients. Obes Surg. 2012;22:1016–21.

    Article  PubMed  Google Scholar 

  20. Gunneson TJ, Menon KV, Wiesner RH, et al. Ultrasound-assisted percutaneous liver biopsy performed by a physician assistant. Am J Gastroenterol. 2002;97:1472–5.

    Article  PubMed  Google Scholar 

  21. Szymczak A, Simon K, Inglot M, et al. Safety and effectiveness of blind percutaneous liver biopsy: analysis of 1412 procedures. Hepat Mon. 2012;12:32–7.

    PubMed Central  PubMed  Google Scholar 

  22. Ratziu V, Charlotte F, Heurtier A, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898–906.

    Article  PubMed  Google Scholar 

  23. Tanwar S, Trembling PM, Guha IN, Parkes J, Kaye P, Burt AD, Ryder SD, et al. Validation of PIIINP for the detection and assessment of non-alcoholic steatohepatitis in patients with non-alcoholic fatty liver disease. Hepatology 2013; (in press).

  24. Poynard T, Ratziu V, Charlotte F, et al. Diagnostic value of biochemical markers (NASH test) for the prediction of non alcoholo steato hepatitis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol. 2006;6:34.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Younossi ZM, Jarrar M, Nugent C, et al. A novel diagnostic biomarker panel for obesity-related nonalcoholic steatohepatitis (NASH). Obes Surg. 2008;18:1430–7.

    Article  PubMed  Google Scholar 

  26. Moretto M, Kupski C, da Silva VD, et al. Effect of bariatric surgery on liver fibrosis. Obes Surg. 2012;22:1044–9.

    Article  PubMed  Google Scholar 

  27. Kumar R, Rastogi A, Sharma MK, Bhatia V, Tyagi P, Sharma P, Garg H, et al. Liver stiffness measurements in patients with different stages of nonalcoholic fatty liver disease: diagnostic performance and clinicopathological correlation. Dig Dis Sci 2013; (in press).

  28. McPherson S, Stewart SF, Henderson E, et al. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59:1265–9.

    Article  PubMed  Google Scholar 

  29. Ruffillo G, Fassio E, Alvarez E, et al. Comparison of NAFLD fibrosis score and BARD score in predicting fibrosis in nonalcoholic fatty liver disease. J Hepatol. 2011;54:160–3.

    Article  PubMed  Google Scholar 

  30. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23:469–80.

    Article  CAS  PubMed  Google Scholar 

  31. Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.

    Article  PubMed  Google Scholar 

  32. Brunt EM. Grading and staging the histopathological lesions of chronic hepatitis: the Knodell histology activity index and beyond. Hepatology. 2000;31:241–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of Interest Disclosure Statement

The authors declare no conflict of interest.

Funding

No financial support was received for this study.

Author information

Authors and Affiliations

  1. HPB Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC, 28204, USA

    Kerri A. Simo, John B. Martinie, David A. Iannitti & David Sindram

  2. Department of Pathology, Carolinas Medical Center, Charlotte, NC, USA

    William A. Ahrens

  3. Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Amanda L. Walters

  4. Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA

    Timothy S. Kuwada & Keith S. Gersin

  5. Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC, 28204, USA

    Iain H. McKillop, Matthew T. McMillan & Kyle J. Thompson

Authors
  1. Kerri A. Simo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iain H. McKillop
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew T. McMillan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William A. Ahrens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amanda L. Walters
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kyle J. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Timothy S. Kuwada
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John B. Martinie
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David A. Iannitti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Keith S. Gersin
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. David Sindram
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Sindram.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simo, K.A., McKillop, I.H., McMillan, M.T. et al. Does a Calculated “NAFLD Fibrosis Score” Reliably Negate the Need for Liver Biopsy in Patients Undergoing Bariatric Surgery?. OBES SURG 24, 15–21 (2014). https://doi.org/10.1007/s11695-013-1044-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-013-1044-6

Keywords

Search

Navigation