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

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 1/2020

01-01-2020 | Bariatric Surgery | Original Contribution

Safety and Utility of Liver Biopsy During Bariatric Surgery in the New Zealand Setting

Authors: Hannah Collins, Grant Beban, John Windsor, Rishi Ram, David Orr, Nicholas Evennett, Benjamin Loveday

Published in: Obesity Surgery | Issue 1/2020

Login to get access

Abstract

Background

Asymptomatic liver disease is common in bariatric patients and can be diagnosed with intraoperative biopsy. This study aimed to establish the risk-benefit profile of routine liver biopsy, prevalence of clinically significant liver disease, relationship between liver pathology and body mass index, and compare outcomes between ethnic groups.

Methods

This retrospective cohort study included all patients who had index bariatric surgery at Auckland City Hospital between 2009 and 2016. Diagnosis of liver disease was based on intraoperative biopsy histology. Outcomes included safety (biopsy-related complication) and utility (liver pathology meeting criteria for referral). Liver pathology and referral rates were compared between ethnic groups.

Results

Of 335 bariatric surgery patients, 234 (70%) underwent intraoperative liver biopsy. There were no biopsy-related complications. Histological findings were as follows: normal 25/234 (11%), non-alcoholic fatty liver disease (NAFLD) 207/234 (88%), and other pathological findings in 35/234 (15%). Histological finding meeting referral criteria was present in 22/234 (9%). Of these, 12/22 (55%) were referred. Number needed to biopsy to identify histology meeting referral criteria: n = 11. Māori had a similar NAFLD rate to non-Māori [51/56 versus 156/178, p = 0.48]. Pasifika patients had a higher rate than non-Pasifika [39/40 versus 168/194, p = 0.049]. Māori and Pasifika patients had similar referral rates to non-Māori and non-Pasifika [2/3 versus 5/9, p = 0.73; 2/2 versus 5/10, p = 0.19].

Conclusions

Intraoperative liver biopsy during bariatric surgery is safe and identified liver disease in 89%, with 9% meeting referral criteria. Pasifika patients have a higher rate of NAFLD than non-Pasifika.
Literature
1.
Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006;45(4):600–6.CrossRefPubMed
2.
Mofrad P, Contos MJ, Haque M, et al. Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values. Hepatology. 2003;37(6):1286–92.CrossRefPubMed
3.
Sorrentino P, Tarantino G, Conca P, et al. Silent non-alcoholic fatty liver disease - a clinical-histological study. J Hepatol. 2004;41(5):751–7.CrossRefPubMed
4.
Castéra L, Foucher J, Bernard PH, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51(3):828–35.PubMed
5.
Myers RP, Pomier-Layrargues G, Kirsch R, et al. Discordance in fibrosis staging between liver biopsy and transient elastography using the FibroScan XL probe. J Hepatol. 2012;56(3):564–70.CrossRefPubMed
6.
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(5):1006–16.CrossRefPubMedPubMedCentral
7.
Teixeira AR, Bellodi-Privato M, Carvalheira JB, et al. The incapacity of the surgeon to identify NASH in bariatric surgery makes biopsy mandatory. Obes Surg. 2009;19(12):1678–84.CrossRefPubMed
8.
Dolce CJ, Russo M, Keller JE, et al. Does liver appearance predict histopathologic findings: prospective analysis of routine liver biopsies during bariatric surgery. Surg Obes Relat Dis. 2009;5(3):323–8.CrossRefPubMed
9.
Leoni S, Tovoli F, Napoli L, et al. Current guidelines for the management of non-alcoholic fatty liver disease: a systematic review with comparative analysis. World J Gastroenterol. 2018;24(30):3361–73.CrossRefPubMedPubMedCentral
10.
Praveenraj P, Gomes RM, Kumar S. Prevalence and predictors of non-alcoholic fatty liver disease in morbidly obese South Indian patients undergoing bariatric surgery. Obes Surg. 2015;5(11):2078–87.CrossRef
11.
Petrick A, Benotti P, Wood GC, et al. Utility of ultrasound, trans-aminases, and visual inspection to assess nonalcoholic fatty liver disease in bariatric surgery patients. Obes Surg. 2015;25(12):2368–75.CrossRefPubMedPubMedCentral
12.
Froehlich F, Lamy O, Fried M, et al. Practice and complications of liver biopsy. Dig Dis Sci. 1993;38(8):1480–4.CrossRefPubMed
13.
Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med. 1993;118(2):96–8.CrossRefPubMed
14.
15.
16.
17.
18.
Devereaux PJ, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370(16):1494–503.CrossRefPubMed
19.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
20.
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(6):1313–21.CrossRefPubMed
21.
22.
23.
Hsiang J. Chronic liver diseases: with a focus on hepatitis B, type 2 diabetes, and statins [PhD thesis]. [Auckland]: University of Auckland; 2016. 161 p.
24.
Agresti A. An introduction to categorical data analysis. 2nd ed. New Jersey: John Wiley & Sons, Inc; 2007.CrossRef
25.
Barbois S, Arvieux C, Leroy V, et al. Benefit–risk of intraoperative liver biopsy during bariatric surgery: review and perspectives. Surg Obes Relat Dis. 2017;13(10):1780–6.CrossRefPubMed
26.
Helling TS, Helzberg JH, Nachnani JS, et al. Predictors of nonalcoholic steatohepatitis in patients undergoing bariatric surgery: when is liver biopsy indicated? Surg Obes Relat Dis. 2008;4(5):612–7.CrossRefPubMed
27.
Kleiner DE, Berk PD, Hsu JY, et al. Hepatic pathology among patients without known liver disease undergoing bariatric surgery: observations and a perspective from the Longitudinal Assessment of Bariatric Surgery (LABS) Study. Semin Liver Dis. 2014;34(1):98–107.CrossRefPubMedPubMedCentral
28.
Simo KA, McKillop IH, McMillan MT, et al. Does a calculated “NAFLD fibrosis score” reliably negate the need for liver biopsy in patients undergoing bariatric surgery? Obes Surg. 2013;24(1):15–21.CrossRef
29.
Mahawar KK, Parmar C, Graham Y, et al. Routine liver biopsy during bariatric surgery: an analysis of evidence base. Obes Sur. 2016;26(1):177–81.CrossRef
30.
Mattar SG, Velcu LM, Rabinovitz M, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg. 2005;242(4):610–7.PubMedPubMedCentral
31.
Mummadi RR, Kasturi KS, Chennareddygari S, et al. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6(12):1396–402.CrossRefPubMed
32.
Brenner DA. Reversibility of liver fibrosis. Gastroenterol Hepatol. 2013;9(11):737–9.
33.
Lee Y, Doumouras AG, Yu J, et al. Complete resolution of nonalcoholic fatty liver disease after bariatric surgery: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019;17(6):1040–60.CrossRefPubMed
34.
Mahawar KK, Parmar C, Graham Y, et al. Monitoring of liver function tests after Roux-en-Y gastric bypass: an examination of evidence base. Obes Surg. 2016;26(10):2516–22.CrossRefPubMed
35.
Coppell KJ, Miller JC, Gray AR, et al. Obesity and the extent of liver damage among adult New Zealanders: findings from a national survey. Obes Sci Pract. 2015;1(2):67–77.CrossRefPubMedPubMedCentral
36.
37.
Crantock LR, Dillon JF, Hayes PC. Diagnostic laparoscopy and liver disease: experience of 200 cases. Aust NZ J Med. 1994;24(3):258–62.CrossRef
Metadata
Title
Safety and Utility of Liver Biopsy During Bariatric Surgery in the New Zealand Setting
Authors
Hannah Collins
Grant Beban
John Windsor
Rishi Ram
David Orr
Nicholas Evennett
Benjamin Loveday
Publication date
01-01-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 1/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04161-3

Other articles of this Issue 1/2020

Obesity Surgery 1/2020 Go to the issue

Original Contributions

Self-Reported Smoking Compared to Serum Cotinine in Bariatric Surgery Patients: Smoking Is Underreported Before the Operation

Original Contributions

The Effect of the Intra-gastric Balloon on Gastric Emptying and the DeMeester Score

Brief Communication

Impact of Statewide Essential Health Benefits on Utilization of Bariatric Surgery

Original Contributions

Internalizing, Externalizing, and Interpersonal Components of the MMPI-2-RF in Predicting Weight Change After Bariatric Surgery

Original Contributions

Perioperative Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Patients with Diabetes Mellitus: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

Original Contributions

The Effect of One Anastomosis Gastric Bypass on Branched-Chain Fatty Acid and Branched-Chain Amino Acid Metabolism in Subjects with Morbid Obesity