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The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients.

Publication ,  Conference
Shalhub, S; Parsee, A; Gallagher, SF; Haines, KL; Willkomm, C; Brantley, SG; Pinkas, H; Saff-Koche, L; Murr, MM
Published in: Obes Surg
January 2004

BACKGROUND: Nonalcoholic Steatohepatitis (NASH) commonly occurs in obese patients and predisposes to cirrhosis. Prevalence of NASH in bariatric patients is unknown. Our aim was to determine the role of routine liver biopsy in managing bariatric patients. METHODS: Prospective data on patients undergoing Roux-en-Y gastric bypass (RYGBP) was analyzed. One pathologist graded all liver biopsies as mild, moderate or severe steatohepatitis. NASH was defined as steatohepatitis without alcoholic or viral hepatitis. Consecutive liver biopsies were compared to those liver biopsies selected because of grossly fatty livers. RESULTS: 242 patients underwent open and laparoscopic RYGBP from 1998-2001. Routine liver biopsies (68 consecutive patients) and selective liver biopsies (additional 86/174, 49%) were obtained. Findings of cirrhosis on frozen section changed the operation from a distal to a proximal RYGBP. The two groups were similar in age, gender, and BMI. The group with the routine liver biopsies showed a statistically significant larger preponderance of NASH (37% vs 32%). Both groups had a similar prevalence of cirrhosis. Neither BMI nor liver enzymes predicted the presence or severity of NASH. CONCLUSIONS: Routine liver biopsy documented significant liver abnormalities in a larger group of patients compared with selective liver biopsies, thereby suggesting that liver appearance is not predictive of NASH. Liver biopsy remains the gold-standard for diagnosing NASH. We recommend routine liver biopsy during bariatric operations to determine the prevalence and natural history of NASH, which will have important implications in directing future therapeutics for obese patients with NASH and for patients undergoing bariatric procedures.

Duke Scholars

Published In

Obes Surg

DOI

ISSN

0960-8923

Publication Date

January 2004

Volume

14

Issue

1

Start / End Page

54 / 59

Location

United States

Related Subject Headings

  • Surgery
  • Severity of Illness Index
  • Prospective Studies
  • Preoperative Care
  • Obesity, Morbid
  • Middle Aged
  • Male
  • Liver Function Tests
  • Humans
  • Gastric Bypass
 

Citation

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Shalhub, S., Parsee, A., Gallagher, S. F., Haines, K. L., Willkomm, C., Brantley, S. G., … Murr, M. M. (2004). The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. In Obes Surg (Vol. 14, pp. 54–59). United States. https://doi.org/10.1381/096089204772787293
Shalhub, Sherene, Anna Parsee, Scott F. Gallagher, Krista L. Haines, Chris Willkomm, Stephen G. Brantley, Haim Pinkas, Lisa Saff-Koche, and Michel M. Murr. “The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients.” In Obes Surg, 14:54–59, 2004. https://doi.org/10.1381/096089204772787293.
Shalhub S, Parsee A, Gallagher SF, Haines KL, Willkomm C, Brantley SG, et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. In: Obes Surg. 2004. p. 54–9.
Shalhub, Sherene, et al. “The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients.Obes Surg, vol. 14, no. 1, 2004, pp. 54–59. Pubmed, doi:10.1381/096089204772787293.
Shalhub S, Parsee A, Gallagher SF, Haines KL, Willkomm C, Brantley SG, Pinkas H, Saff-Koche L, Murr MM. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004. p. 54–59.
Journal cover image

Published In

Obes Surg

DOI

ISSN

0960-8923

Publication Date

January 2004

Volume

14

Issue

1

Start / End Page

54 / 59

Location

United States

Related Subject Headings

  • Surgery
  • Severity of Illness Index
  • Prospective Studies
  • Preoperative Care
  • Obesity, Morbid
  • Middle Aged
  • Male
  • Liver Function Tests
  • Humans
  • Gastric Bypass