title: Routine liver biopsy to screen for nonalcoholic fatty liver disease (NAFLD) during cholecystectomy for gallstone disease: is it justified?
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) share common risk factors. There are no firm recommendations regarding screening of NAFLD in patients at risk. Our aim was to assess the prevalence of and factors associated with NAFLD in a cohort of patients operated for symptomatic GD and evaluate the usefulness of routine liver biopsy.
  
  
  METHODS
  Ninety-five consecutive patients underwent a liver biopsy at the end of a standard laparoscopic cholecystectomy for symptomatic GD. Clinical, biochemical, demographic, and anthropometric variables were obtained prospectively.
  
  
  RESULTS
  Fifty-two patients (55%) had biopsies compatible with NAFLD. These patients were classified according to the system proposed by Brunt et al. as follows: grade I, n = 27 (52%); grade II, n = 15 (29%); grade III, n = 10 (19%). Two grade III patients had zone III focal perisinusoidal fibrosis and three had overt cirrhosis. Only 13% of subjects had a suspected diagnosis of NAFLD preoperatively. In multivariate logistic regression, only obesity was significantly associated with NAFLD. There were no complications or mortality.
  
  
  CONCLUSIONS
  Fifty-five percent of patients with GD have associated NAFLD. Awareness of this association may result in an earlier diagnosis. The high prevalence of NAFLD in patients with GD may justify routine liver biopsy during cholecystectomy to establish the diagnosis, stage, and possible direct therapy.
authors.affiliation: Gastroenterology and Gastrointestinal Surgery Department, Veracruz Regional Hospital, Veracruz, México. ramos.antonio@inbox.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramos-De la Medina
authors.forename: José M
authors.initials: JM
authors.lastname: Remes-Troche
authors.forename: Federico B
authors.initials: FB
authors.lastname: Roesch-Dietlen
authors.forename: Alfonso G
authors.initials: AG
authors.lastname: Pérez-Morales
authors.forename: Silvia
authors.initials: S
authors.lastname: Martinez
authors.forename: Silvia
authors.initials: S
authors.lastname: Cid-Juarez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic; D041761:Cholecystolithiasis / Q000150:complications* / Q000601:surgery*; D005234:Fatty Liver / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors