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Intraoperative Liver Biopsy During Adolescent Bariatric Surgery: Is It Really Necessary?

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Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) is prevalent in children with obesity and is definitively diagnosed with liver biopsy. However, the utility of routine biopsy during adolescent bariatric surgery remains unknown. We describe the usefulness of routine versus selective intraoperative liver biopsy in adolescents undergoing bariatric surgery.

Methods

A retrospective review of adolescents who received bariatric surgery at our institution between 2007 and 2018 was performed. Prior to 2014, all patients routinely received intraoperative liver biopsy. After 2014, biopsy was performed selectively on an individual basis for transaminitis or clinical concern. Demographic, biochemical, and histopathologic data were compared between patients who underwent routine, selective, or no biopsy.

Results

There were 77 patients who received bariatric surgery during the study period: 32 underwent routine biopsy, 13 selective biopsy, and 32 no biopsy. Selective liver biopsy was more likely to show pathologic evidence of fibrosis (84.6% versus 31.2%, p = 0.000) and steatosis (100.0% versus 59.4%, p = 0.003), and higher mean NAFLD activity score compared with routine biopsies (4.4 versus 2.1, p = 0.001). Patients with steatosis had significantly higher preoperative fasting insulin (41.4 versus 21.1 mIU/L, p = 0.000), and patients with fibrosis had significantly higher glycated hemoglobin (6.1% versus 5.5%, p = 0.033) and alanine aminotransferase (81.5 versus 52.7 mg/dL, p = 0.043). There were no biopsy complications or changes in management due to biopsy results.

Conclusions

Routine intraoperative liver biopsy during adolescent bariatric surgery possesses questionable benefit, as it does not appear to impact short-term postoperative management. Prospective, longitudinal studies are needed to better understand the meaningfulness of liver histopathology in this population.

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Authors and Affiliations

  1. Department of Surgery, Division of Pediatric Surgery, Stanford University Medical Center, 300 Pasteur Dr Rm M116, Alway Bldg MC 5733, Stanford, CA, 94305, USA

    R. Ellen Jones, Janey Pratt & Matias Bruzoni

  2. Department of Pediatrics, Division of Gastroenterology, Stanford University Medical Center, Stanford, CA, USA

    Ann Ming Yeh & Marwa Abu El Haija

  3. Department of Clinical Pathology, Stanford University Medical Center, Stanford, CA, USA

    Neerajah Kambham

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  1. R. Ellen Jones
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  2. Ann Ming Yeh
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Correspondence to Matias Bruzoni.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Jones, R.E., Yeh, A.M., Kambham, N. et al. Intraoperative Liver Biopsy During Adolescent Bariatric Surgery: Is It Really Necessary?. OBES SURG 30, 69–76 (2020). https://doi.org/10.1007/s11695-019-04136-4

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