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Obesity Surgery
Published in: Obesity Surgery 3/2018

01-03-2018 | Original Contributions

Non-invasive Evaluation of NAFLD with Indocyanine Green Clearance Test: a Preliminary Study in Morbidly Obese Patients Undergoing Bariatric Surgery

Authors: Pierre Eric Danin, Rodolphe Anty, Stephanie Patouraux, Marc Raucoules-Aimé, Jean Gugenheim, Albert Tran, Philippe Gual, Antonio Iannelli

Published in: Obesity Surgery | Issue 3/2018

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Abstract

Background

Overweight and obesity dramatically increased in the last years. Hepatic complication of obesity, integrated in the term of non-alcoholic fatty liver disease (NAFLD), is a spectrum of abnormality ranging from steatosis to non-alcoholic steatohepatitis (NASH), potentially leading to cirrhosis. Liver biopsy remains the gold standard to evaluate the stage of NAFLD; however, the procedure is invasive. The indocyanine green (ICG) clearance test is performed since years to assess hepatic function before partial hepatectomy, or after liver transplantation. This study was designed to detect liver complications with the ICG clearance test in a population of obese patients scheduled for bariatric surgery.

Methods

In a prospective cohort study, morbidly obese individuals receiving bariatric surgery with scheduled hepatic biopsies were investigated. Liver function was determined by the ICG test preoperatively, and blood samples were collected. Liver biopsy specimens were obtained for each patient and classified according to the NAFLD activity score (NAS) by a single pathologist that was blinded to the results of the ICG test.

Results

Twenty-six patients were included (7 male and 19 female). The mean age of participants was 45.8 years; the mean body mass index was 41.4 kg/m2. According to the NAS, 6 (23.1%) patients revealed manifest NASH, and 5 patients were considered borderline (19.2%). A closed correlation was observed between the ICG clearance test and hepatic steatosis (r = 0.43, p = 0.03), NAS (r = 0.44, p = 0.025), and fibrosis (r = 0.49, p = 0.01).

Conclusions

In obese patients, non-invasive evaluation of liver function with the indocyanine green clearance test correlated with histological features of NAFLD. This may detect non-invasively hepatopathy in obese population and could motive biopsy.
Literature
1.
Kelly T, Yang W, Chen C-S, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32:1431–7.
2.
Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.CrossRefPubMed
3.
4.
Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology; 2016;64:73–84.
5.
Sanyal AJ, Banas C, Sargeant C, et al. Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C. Hepatology. 2006;43:682–9.
6.
Anty R, Iannelli A, Patouraux S, et al. A new composite model including metabolic syndrome, alanine aminotransferase and cytokeratin-18 for the diagnosis of non-alcoholic steatohepatitis in morbidly obese patients. Aliment Pharmacol Ther. 2010;32:1315–22.CrossRefPubMed
7.
Machado MV, Cortez-Pinto H. Non-invasive diagnosis of non-alcoholic fatty liver disease. A critical appraisal. J. Hepatol. 2013;58:1007–19.CrossRefPubMed
8.
Brunt EM, Kleiner DE, Wilson LA, et al. Nonalcoholic fatty liver disease (NAFLD) activity score and the histopathologic diagnosis in NAFLD: distinct clinicopathologic meanings. Hepatology. 2011;53:810–20.
9.
Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142:1592–609.CrossRefPubMed
10.
11.
Piccinino F, Sagnelli E, Pasquale G, et al. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J. Hepatol. 1986;2:165–73.CrossRefPubMed
12.
Dyson JK, McPherson S, Anstee QM. Non-alcoholic fatty liver disease: non-invasive investigation and risk stratification. J Clin Pathol. 2013;66:1033–45.CrossRefPubMed
13.
Janssen MWW, Druckrey-Fiskaaen KT, Omidi L, et al. Indocyanine green R15 ratio depends directly on liver perfusion flow rate. J Hepato-Biliary-Pancreat Sci. 2010;17:180–5.CrossRef
14.
Levesque E, Martin E, Dudau D, et al. Current use and perspective of indocyanine green clearance in liver diseases. Anaesth Crit Care Pain Med. 2016;35:49–57.CrossRefPubMed
15.
Imamura H, Sano K, Sugawara Y, et al. Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepato-Biliary-Pancreat Surg. 2005;12:16–22.CrossRef
16.
de Liguori CN, O’Reilly DA, Dajani K, et al. Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure. Eur. J. Surg. Oncol. J. Eur. Soc. Surg. Oncol. Br. Assoc. Surg. Oncologia. 2009;35:957–62.
17.
Thomas MN, Weninger E, Angele M, et al. Intraoperative simulation of remnant liver function during anatomic liver resection with indocyanine green clearance (LiMON) measurements. HPB. 2015;17:471–6.CrossRefPubMedPubMedCentral
18.
Haegele S, Reiter S, Wanek D, et al. Perioperative non-invasive Indocyanine green-clearance testing to predict postoperative outcome after liver resection. PLoS One. 2016;11:e0165481.CrossRefPubMedPubMedCentral
19.
National Task Force on the Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Arch. Intern. Med. 2000;160:898–904.CrossRef
20.
Vos JJ, Wietasch JKG, Absalom AR, et al. Green light for liver function monitoring using indocyanine green? An overview of current clinical applications. Anaesthesia. 2014;69:1364–76.CrossRefPubMed
21.
Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.
22.
Iannelli A, Schneck A-S, Hébuterne X, et al. Gastric pouch resizing for Roux-en-Y gastric bypass failure in patients with a dilated pouch. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2013;9:260–7.CrossRef
23.
Ratziu V, Charlotte F, Heurtier A, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology. 2005;128:1898–906.CrossRefPubMed
24.
Goossens N, Hoshida Y, Song WM, et al. Nonalcoholic steatohepatitis is associated with increased mortality in obese patients undergoing bariatric surgery. Clin Gastroenterol Hepatol. 2016 ;14:1619-1628.
25.
Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006;45:600–6.CrossRefPubMed
26.
Fracanzani AL, Valenti L, Bugianesi E, et al. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008;48:792–8.
27.
Chalasani N. Nonalcoholic fatty liver disease liver fat score and fat equation to predict and quantitate hepatic steatosis: promising but not prime time! Gastroenterology. 2009;137:772–5.CrossRefPubMed
28.
Cusi K, Chang Z, Harrison S, et al. Limited value of plasma cytokeratin-18 as a biomarker for NASH and fibrosis in patients with non-alcoholic fatty liver disease. J Hepatol. 2014;60:167–74.CrossRefPubMed
29.
Mehta SR, Thomas EL, Patel N, et al. Proton magnetic resonance spectroscopy and ultrasound for hepatic fat quantification. Hepatol Res. 2010;40:399–406.
30.
Hernaez R, Lazo M, Bonekamp S, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology. 2011;54:1082–90.
31.
Tsochatzis EA, Gurusamy KS, Ntaoula S, et al. Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. J Hepatol. 2011;54:650–9.CrossRefPubMed
32.
Castéra L, Foucher J, Bernard P-H, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51:828–35.
33.
34.
Hedderich DM, Hasenberg T, Haneder S, et al. Effects of bariatric surgery on non-alcoholic fatty liver disease: magnetic resonance imaging is an effective, non-invasive method to evaluate changes in the liver fat fraction. Obes Surg. 2017;27:1755-1762.
35.
Dulai PS, Sirlin CB, Loomba R. MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: clinical trials to clinical practice. J Hepatol. 2016;65:1006–16.CrossRefPubMedPubMedCentral
36.
Loomba R, Wolfson T, Ang B, et al. Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology. 2014;60:1920–8.
37.
38.
Shigefuku R, Takahashi H, Nakano H, et al. Correlations of hepatic hemodynamics, liver function, and fibrosis markers in nonalcoholic fatty liver disease: comparison with chronic hepatitis related to hepatitis C virus. Int J Mol Sci. 2016;17(9). https://​doi.​org/​10.​3390/​ijms17091545.
39.
Yang Y-L, Di L, Duan Y-Y, et al. A prospective experimental study of liver fibrosis with ultrasound and its correlation with hepatic reserve function and hemodynamics. BMC Gastroenterol. 2012;12:168.CrossRefPubMedPubMedCentral
40.
Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149:389–397.e10.CrossRefPubMedPubMedCentral
41.
Ekstedt M, Hagström H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61:1547–54.
42.
Pind M-LL, Bendtsen F, Kallemose T, et al. Indocyanine green retention test (ICG-r15) as a noninvasive predictor of portal hypertension in patients with different severity of cirrhosis. Eur J Gastroenterol Hepatol. 2016;28:948–54.CrossRefPubMed
43.
Fisher CD, Lickteig AJ, Augustine LM, et al. Experimental non-alcoholic fatty liver disease results in decreased hepatic uptake transporter expression and function in rats. Eur J Pharmacol. 2009;613:119–27.CrossRefPubMedPubMedCentral
44.
Alizai PH, Wendl J, Roeth AA, et al. Functional liver recovery after bariatric surgery—a prospective cohort study with the LiMAx test. Obes Surg. 2015;25:2047–53.CrossRefPubMed
45.
Lassailly G, Caiazzo R, Buob D, et al. Bariatric surgery reduces features of nonalcoholic steatohepatitis in morbidly obese patients. Gastroenterology. 2015;149:379–88.
46.
Schneck AS, Anty R, Patouraux S, et al. Roux-en Y gastric bypass results in long-term remission of hepatocyte apoptosis and hepatic histological features of non-alcoholic steatohepatitis. Front Physiol. 2016;7:344.
Metadata
Title
Non-invasive Evaluation of NAFLD with Indocyanine Green Clearance Test: a Preliminary Study in Morbidly Obese Patients Undergoing Bariatric Surgery
Authors
Pierre Eric Danin
Rodolphe Anty
Stephanie Patouraux
Marc Raucoules-Aimé
Jean Gugenheim
Albert Tran
Philippe Gual
Antonio Iannelli
Publication date
01-03-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 3/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2914-0

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