Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Hepato-Biliary-Pancreatic Sciences
Published in: Journal of Hepato-Biliary-Pancreatic Sciences 3/2010

01-05-2010 | Original article

Development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: proposal of a postoperative NAFLD scoring system

Authors: Hiroyuki Kato, Shuji Isaji, Yoshinori Azumi, Masashi Kishiwada, Takashi Hamada, Shugo Mizuno, Masanobu Usui, Hiroyuki Sakurai, Masami Tabata

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 3/2010

Login to get access

Abstract

Background

The main etiology of NAFLD and NASH after pancreatic resection is still unclear, and the therapeutic strategy has yet to be established. The focus of this review is how predict and prevent NAFLD/NASH after pancreaticoduodenectomy.

Methods

From April 2005 to October 2008, 54 patients who underwent pancreaticoduodenectomy in our institution were enrolled in this study. From the pre-, intra- and postoperative risk factors, we identified the most influential risk factors of postoperative NAFLD by uni- and multivariate analyses. Moreover, a postoperative NAFLD scoring system was proposed based on these risk factors.

Results

The incidence of postoperative NAFLD was 37.0% (20/54). Of these, 10% (2/20) of patients were diagnosed as having NASH by percutaneous liver biopsy. By multivariate analysis, pancreatic adenocarcinoma (p < 0.05), pancreatic resection line (p < 0.01) and postoperative diarrhea (p < 0.01) were identified as the most influential factors concerning postoperative NAFLD. Based on these results, we proposed a postoperative NAFLD scoring system (0–10) and evaluated the correlation between the score and decreasing rates of CT values, revealing a significant correlation (r = 0.829 p < 0.001). The prevalence of postoperative NAFLD in the patients with our scores of 0–3, 4–6 and 7–10 points was 0 (0/22), 35 (6/17) and 93% (14/15), respectively.

Conclusions

In conclusion, NAFLD develops frequently in patients who undergo PD, and some patients even progress to NASH. A postoperative NAFLD scoring system makes it possible to predict the occurrence of NAFLD after PD, and aggressive nutrition support is needed for patients with high scores.
Appendix
Available only for authorised users
Literature
1.
Kuczmarski RJ, Carroll MD, Flegal KM, Triano RP. Varing body mass index cutoff points to describe overweight prevalence among US adults: NHANES III (1988–1994). Obes Res. 1997;5:542–8.PubMed
2.
Kopelman PG. Obesity as a medical problem. Nature. 2000;404:635–43.PubMed
3.
Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis. 2001;21:17–26.CrossRefPubMed
4.
Day CP. Non-alcoholic steatohepatitis (NASH): where are we now and where are we going? Gut. 2002;50:585–8.CrossRefPubMed
5.
Shen L, Fan JG, Shao Y, Zeng MD, Wang JR, Luo GH, et al. Prevalence of nonalcoholic fatty liver among administrative officers in Shanghai: an epidemiological survey. World J Gastroenterol. 2003;9:1106–10.PubMed
6.
Chitturi S, Farrell GC, George J. Non-alcoholic steatohepatitis in the Asian-Pacific region: future shock? J Gastroenterol Hepatol. 2004;19:368–74.CrossRefPubMed
7.
Kawarada Y, Nakamura K, Kida H, Kita T, Mizumoto R, et al. Problems for a long period of management after pancreaticoduodenectomy–Especially changes of exocrine function of the pancreas and pathophysiological changes after gastrectomy (in Japanese). Nippon Syokakigeka Gakkaizasshi (Jpn J Gastroenterol surg). 1988;21:2496–500.
8.
Mizumoto R, Iwasaki M. Clinics in fatty liver disease. Kan Tan Sui. 1982;5:607–13. (in Japanese).
9.
Tanaka N, Horiuchi A, Yokoyama T, Kawa S, Kiyosawa K, et al. Pancreatic exocrine insufficiency: a rare cause of nonalcoholic steatohepatitis. Am J Gastroenterol. 2008;103:245–6.PubMed
10.
Ricci C, Longo R, Gioulis E, Bosco M, Pollesello P, Masutti F, et al. Noninvasive in vivo quantitative assessment of fat content in human liver. J Hepatol. 1997;27:108–13.CrossRefPubMed
11.
Pamilo M, Sotaniemi EA, Suramo I, Lahde S, Arranto AJ. Evaluation of liver steatotic and fibrous content by computerized tomography and ultrasound. Scand J Gastroenterol. 1983;18:743–7.CrossRefPubMed
12.
Hamer OW, Aguirre DA, Casola G, Sirlin CB. Imaging features of perivascular fatty infiltration of the liver: initial observations. Radiology. 2005;237:159–69.CrossRefPubMed
13.
Butturini G, Daskalaki D, Molinari E, Scopelliti F, Casarotto A, Bassi C. Pancreatic fistula: definition and current problems. J Hepatobiliary Pancreat Surg. 2008;15:247–51.CrossRefPubMed
14.
Shinchi H, Takao S, Maemura K, Aikou T. A new technique for pancreaticogastrostomy for the soft pancreas: the transfixing suture method. J Hepatobiliary Pancreat Surg. 2006;13:212–7.CrossRefPubMed
15.
Sari YS, Koç O, Tunali V, Tomaoğlu K. Choice of the optimal pancreaticojejunal anastomosis technique: how can we improve patient safety in pancreatic surgery? J Hepatobiliary Pancreat Surg. 2008;15:479–82.CrossRefPubMed
16.
Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, Wong J. Ann Surg 2007; 246:425–33 (discussion 433-5).
17.
18.
Allard JP. Other disease associations with non-alcoholic fatty liver disease (NAFLD). Best Pract Res Clin Gastroenterol. 2002;16:783–95.CrossRefPubMed
19.
Isaji S. Nutritional change and management at the long-term period after major pancreatectomy. Eiyo Hyoka to chiryo (JPN J Nutritional Assessment). 2006;23:34–8. (in Japanese).
20.
Mizumoto R, Kawarada Y, Goshima H, Tamaki H, Sekoguchi T, Tomikawa I. Carbohydrate metabolism and endocrine function in the pancreas remnant after major pancreatic resection. Am J Surg. 1982;143:237–43.CrossRefPubMed
21.
Chitturi S, Farrell G. Ethiopathogenesis of nonalcoholic steatohepatitis. Semin Liver Dis. 2001;21:27–41.CrossRefPubMed
22.
Tilg H, Diehl AM. Cytokines in alcoholic and nonalcoholic steatohepatitis. N Engl J Med. 2000;343:1467–76.CrossRefPubMed
23.
Wigg AJ, Roberts-Thomson IC, Dymock RB, McCarthy PJ, Grose RH, Cummins AG. The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor β in the pathogenesis of nonalcoholic steatohepatitis. Gut. 2001;48:206–11.CrossRefPubMed
24.
Oliveira CP, da Costa Gayotto LC, Tatai C, Della Bina BI, Janiszewski M, Lima ES, et al. Oxidative stress in the pathogenesis of nonalcoholic fatty liver disease, in rats fed with a choline-deficient diet. J Cell Mol Med. 2002;6:399–406.CrossRefPubMed
25.
Griffin IJ, Kim SC, Hicks PD, Liang LK, Abrams SA. Zinc metabolism in adolescents with Crohn’s disease. Pediatr Res. 2004;56:235–9.CrossRefPubMed
26.
Sturniolo GC, Fries W, Mazzon E, Di Leo V, Barollo M, D’inca R. Effect of zinc supplementation on intestinal permeability in experimental colitis. J Lab Clin Med. 2002;139:311–5.CrossRefPubMed
27.
Hennig B, Wang Y, Ramasamy S, McClain CJ. Zinc deficiency alters barrier function of cultured porcine endothelial cells. J Nutr. 1992;122:1242–7.PubMed
28.
Kato K, Isaji S, Kawarada Y, Hibasami H, Nakashima K. Effect of zinc administration on pancreatic regeneration after 80% pancreatectomy. Pancreas. 1997;14:158–65.CrossRefPubMed
29.
Bydder GM, Chapman RW, Harry D, Bassan L, Sherlock S, Kreel L. Computed tomography attenuation values in fatty liver. J Comput Tomogr. 1981;5:33–5.CrossRefPubMed
30.
Ricci C, Longo R, Gioulis E, Bosco M, Pollesello P, Masutti F, et al. Noninvasive in vivo quantitative assessment of fat content in human liver. J Hepatol. 1997;27:108–13.CrossRefPubMed
31.
Pamilo M, Sotaniemi EA, Suramo I, Lahde S, Arranto AJ. Evaluation of liver steatotic and fibrous content by computerized tomography and ultrasound. Scand J Gastroenterol. 1983;18:743–7.CrossRefPubMed
Metadata
Title
Development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: proposal of a postoperative NAFLD scoring system
Authors
Hiroyuki Kato
Shuji Isaji
Yoshinori Azumi
Masashi Kishiwada
Takashi Hamada
Shugo Mizuno
Masanobu Usui
Hiroyuki Sakurai
Masami Tabata
Publication date
01-05-2010
Publisher
Springer Japan
Published in
Journal of Hepato-Biliary-Pancreatic Sciences / Issue 3/2010
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-009-0187-2

Other articles of this Issue 3/2010

Journal of Hepato-Biliary-Pancreatic Sciences 3/2010 Go to the issue

Original article

Is 18F-fluorodeoxyglucose positron emission tomography meaningful for estimating the efficacy of corticosteroid therapy in patients with autoimmune pancreatitis?

Original article

Role of triggering receptor expressed on myeloid cells-1 in experimental severe acute pancreatitis

Original article

Sonographic demonstration of wall thickness of the gallbladder in pediatric patients with pancreatico-biliary maljunction

Original article

Immunohistochemical study of mucin expression in periampullary adenomyoma

Image of interest

Utility of narrow band imaging for identification of the orifice of the bile duct during ERCP

Original article

Development of a novel reflux-free bilioenteric anastomosis procedure by using a bioabsorbable polymer tube