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Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients

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Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) is common in adults with extreme obesity and can impact long-term health and survival. Liver biopsy is the only accurate test for diagnosis and staging, but is invasive and costly. Non-invasive testing offers an attractive alternate, but the overall accuracy remains a significant issue. This study was conducted to determine the accuracy and clinical utility of pre-operative ultrasound and liver transaminase levels, as well as intra-operative hepatic visual inspection, for assessing presence of NAFLD as confirmed by hepatic histology.

Methods

Data was collected prospectively from 580 morbidly obese adult patients who underwent Roux-en-Y gastric bypass surgery with intraoperative wedge biopsy between January 2004 and February 2009. Complete data for ultrasound, ALT and AST levels, and documented visual inspection was available for 513 patients.

Results

The prevalence of NAFLD was 69 % and that of NASH was 32 %. The individual non-invasive clinical assessments demonstrated low sensitivity, specificity, and accuracy for detecting the presence of steatosis, steatohepatitis, or fibrosis. The combination of normal or abnormal results for all tests improved predictive utility. Abnormal tests with all three assessments had a sensitivity of 95–98 % and a specificity of 28–48 % for major histologic findings in NAFLD/NASH. Normal tests with all three assessments had a sensitivity of 12–22 % and a specificity of 89–97 % for major histologic findings in NAFLD/NASH.

Conclusions

Although individual clinical tests for NAFLD have limited accuracy, the use of combined clinical tests may prove useful.

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Acknowledgments

This work was supported by funding from the National Institutes of Health grants DK091601, DK088231, P30 DK072488, and the Geisinger Obesity Institute.

Conflict of Interest

The authors declare that they have no competing interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

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Authors and Affiliations

  1. Geisinger Obesity Research Institute, Danville, PA, USA

    Anthony Petrick, Peter Benotti, G. Craig Wood, Christopher D. Still, William E. Strodel, John Gabrielsen, David Rolston, Xin Chu, George Argyropoulos & Anna Ibele

  2. Temple University School of Medicine, Philadelphia, PA, USA

    Glenn S. Gerhard

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  1. Anthony Petrick
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  2. Peter Benotti
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  3. G. Craig Wood
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Correspondence to Peter Benotti.

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Petrick, A., Benotti, P., Wood, G.C. et al. Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients. OBES SURG 25, 2368–2375 (2015). https://doi.org/10.1007/s11695-015-1707-6

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