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Bariatric Surgery in Nonalcoholic Fatty Liver Disease (NAFLD): Impact Assessment Using Paired Liver Biopsy and Fibroscan

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Abstract

Background

Bariatric surgery is associated with a positive impact on the degree of hepatic steatosis and inflammation in nonalcoholic associated fatty liver disease (NAFLD), although its effect on fibrosis is contentious. The role of Fibroscan in the post-bariatric assessment of hepatic steatosis and fibrosis is unclear.

Objectives

This work aims to study the impact of bariatric surgery on the course of NAFLD using both invasive (liver biopsy) and non-invasive tests (biochemical parameters and Fibroscan).

Methods

In this prospective study, the impact of bariatric surgery on the course of NAFLD was assessed using paired liver biopsy (intra-operative and post-bariatric surgery 1-year follow-up). The liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) cutoffs for the assessment of hepatic fibrosis and steatosis, respectively, were calculated in both pre- and post-bariatric settings.

Results

Fifty-eight patients (70.7% females, mean age 39.2 years) underwent paired liver biopsy. Post-bariatric surgery 1-year liver biopsy showed significant improvement in all the histopathological parameters of NAFLD. The mean NAFLD Activity Score declined from 2.81 (± 1.08) to 1.31 (± 1.39) post-bariatric surgery. Thirty (51.7%) patients showed improvement in fibrosis, eighteen (31%) no change, and ten (17.2%) had worsening. Worsening of fibrosis was associated with a higher median age of 44.5 versus 38 years (p value = 0.033). The CAP cutoff values for the various stages of hepatic steatosis were higher pre-operatively as compared with those obtained post-bariatric surgery.

Conclusions

Bariatric surgery is associated with significant improvement in histopathological parameters of NAFLD. Fibroscan shows good diagnostic accuracy in detecting advanced stage and grade of NAFLD.

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Authors and Affiliations

  1. Departments of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India

    Lokesh Agarwal, Sandeep Aggarwal & Harshit Garg

  2. Departments of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Shalimar

  3. Departments of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Rajni Yadav & Siddhartha Dattagupta

  4. Departments of Internal Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Samagra Agarwal

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  1. Lokesh Agarwal
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  2. Sandeep Aggarwal
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  3. Shalimar
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Correspondence to Sandeep Aggarwal.

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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.

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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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Fig. S1

The ROC curves of LSM for differentiation of various stages of hepatic fibrosis using liver biopsy as the reference, in both pre and post-bariatric surgery settings. a) Significant fibrosis (F01 vs. F2-4), pre-bariatric surgery; b) Significant fibrosis (F01 vs. F2-4), 1-year post-bariatric surgery; c) Advanced fibrosis (F0-2 vs. F3, 4), pre-bariatric surgery; d) Advanced fibrosis (F0-2 vs. F3, 4), 1-year post-bariatric surgery; e) Cirrhosis (F0-3 vs. F4), pre-bariatric surgery; f) Cirrhosis (F0-3 vs. F4), 1-year post-bariatric surgery. (PNG 108 kb)

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Agarwal, L., Aggarwal, S., Shalimar et al. Bariatric Surgery in Nonalcoholic Fatty Liver Disease (NAFLD): Impact Assessment Using Paired Liver Biopsy and Fibroscan. OBES SURG 31, 617–626 (2021). https://doi.org/10.1007/s11695-020-04977-4

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  • DOI: https://doi.org/10.1007/s11695-020-04977-4

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