Should Surgeons Accept Liver Biopsy As a Standard Practice When Performing Bariatric Surgery?

Manpreet K Kohli, MD, Frank Borao, MD, Steven Binenbaum, Jurek Kocik. Monmouth Medical Center, Long Branch, NJ

Introduction

We explore one center’s experience in performing liver biopsies routinely with bariatric surgery in the aim of detecting Nonalcoholic Fatty Liver Diseases (NAFLD). 

Methods and Procedures

A retrospective review of 142 cases between January 1, 2007 through October 15, 2010 in which liver biopsies were performed with a variety of bariatric prodecures. Comparisons were made between patient populations with specific comorbidities and incidence of Nonalcoholic Steatohepatitis (NASH).
 

Results

Of 142 patients studies 93% were found to have a pathological diagnosis of one of the Nonalcoholic Fatty Liver Diseases. Seventy six percent of the population was found to have Steatosis on liver biopsy and 17% had the pre-cirrhotic stage Nonalcoholic Steatohepatitis. Comorbidities most frequently associated with NASH were hypertension, gastroesophageal incompetence, and diabetes mellitus.
 

Conclusions

Our series reports a lower incidence of NASH than comparable studies and a high overall incidence of NAFLD in the population studied. Early detection of NAFLD by liver biopsy during bariatric surgery can help identify patients who will require surveillance and prevent progression from Steatosis to Steatohepatitis. Our experience demonstrates that liver biopsy is a safe and effective diagnostic tool that should be routinely utilized in all bariatric procedures.

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