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Applicability and Results of Liver Stiffness Measurement and Controlled Attenuation Parameter Using XL Probe for Metabolic-Associated Fatty Liver Disease in Candidates to Bariatric Surgery. A Single-Center Observational Study

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Abstract

Purpose

Patients with morbid obesity are at high risk of liver fibrosis due to metabolic-associated fatty liver disease. Data on liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) by vibration-controlled transient elastography (VCTE, FibroScan®) XL probe for liver fibrosis and steatosis assessment in morbid obesity are needed.

Materials and Methods

LSM and CAP were measured in candidates to bariatric surgery at a single center during 12 months. In patients who underwent an intraoperative liver biopsy, we compared LSM and CAP with histology findings. Comorbidities, body mass index, type of surgery, and infections after surgery were collected and analyzed.

Results

Of the eighty-three patients assessed by XL probe, 49 (59%; female in 63%, BMI 42.6 ± 5.1 kg/m2) had a valid LSM and CAP measurement. LSM was 7.0 ± 3.9 kPa and CAP 329 ± 57 dB/m. In the 14 patients undergoing intraoperative liver biopsy, all had steatosis (severe in 50%), 6 (43%) had NASH (NAS ≥ 5), and 4 (29%) showed significant or bridging fibrosis. LSM accurately discriminated between patients with and without significant or severe fibrosis (AUROC 0.833) and CAP well-identified patients with or without ≥S2 steatosis (AUROC 0.896). Nine of 49 patients (18%) tested positive for significant/severe fibrosis by LSM (cut-off 8.9 kPa).

Conclusion

Applicability of LSM and CAP by XL probe in patients candidate to bariatric surgery was moderate. However, when technically successful, their reliability to diagnose severe steatosis and fibrosis related to MAFLD was good.

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Abbreviations

ACLD:

Advanced chronic liver disease

BMI:

Body mass index

CAP:

Controlled attenuation parameter

CSPH:

Clinically significant portal hypertension

LSM:

Liver stiffness measurement

MAFLD:

Metabolic-associated fatty liver disease

MASH:

Metabolic-associated steatohepatitis

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

VCTE:

Vibration-controlled transient elastography

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Authors and Affiliations

  1. Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland

    Tao Wan, Nastassja Köhn, Dino Kröll & Annalisa Berzigotti

  2. Department of Biomedical Research, University of Bern, Bern, Switzerland

    Tao Wan & Annalisa Berzigotti

  3. Department of Hepatobiliary Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China

    Tao Wan

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  1. Tao Wan
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  2. Nastassja Köhn
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  4. Annalisa Berzigotti
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Contributions

TW and NK, data collection; TW, drafting of the manuscript; DK, critical revision of the manuscript for important intellectual content; AB, conceptualization, supervision of the study, improvement of the manuscript. All the authors: approval of the final version of the manuscript.

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Correspondence to Annalisa Berzigotti.

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The authors declare that they have no conflict of interest.

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

All procedures 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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Tao Wan is supported by a scholarship by the China Scholarship Council (CSC).

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Wan, T., Köhn, N., Kröll, D. et al. Applicability and Results of Liver Stiffness Measurement and Controlled Attenuation Parameter Using XL Probe for Metabolic-Associated Fatty Liver Disease in Candidates to Bariatric Surgery. A Single-Center Observational Study. OBES SURG 31, 702–711 (2021). https://doi.org/10.1007/s11695-020-04971-w

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