Letter to the Editor Re: “Evaluation of Liver Function Tests and Risk Score Assessment to Screen Patients for Significant Liver Disease Prior to Bariatric and Metabolic Surgery”

Excerpt

We congratulate Dr. Antonis Antipass and his colleagues for their significant contribution exploring pre-operative evaluation of fatty liver disease severity before bariatric surgery to avoid the rare but dangerous outcomes of hepatic disease progression to fulminant hepatic failure or variceal bleeding. This group has adeptly recognized that there are no guidelines for detecting those with fatty liver disease who are at risk of disease progression rather than regression or resolution after bariatric surgery, despite the usual improvement of fatty liver disease and fibrosis as well as multiple other obesity-related comorbidities often seen following bariatric surgery. They highlight the unfortunate reality that around 20% of patients with liver fibrosis have normal AST and ALT values, and that these values alone are insufficient to screen for fatty liver disease or its sequelae. They compared the FIB-4 and NAFLD scores, which are non-invasive composite measurements using transaminases, platelet count, age (FIB-4), BMI, albumin, and glucose intolerance (NAFLD). …