The incapacity of the surgeon to identify NASH in bariatric surgery makes biopsy mandatory.
BACKGROUND
Nonalcoholic steatohepatitis (NASH) is a morbid condition highly related to obesity. It is unclear if the macroscopic liver appearance correlates with the histopathologic findings. The goal of this prospective study was to determine the relationship between the intraoperative liver appearance and the histopathologic diagnosis of NASH in morbidly obese subjects undergoing bariatric surgery. We also aimed to determine variables that could predict NASH preoperatively.


METHODS
Consecutive 51 subjects undergoing bariatric surgery without evidence of other liver disease underwent intraoperative liver biopsy. An intraoperative liver visual (macroscopic and tactile examination) was recorded. The liver aspect was compared with the liver histologic findings. Histological assessment was categorized into two groups: NASH and non-NASH (including normal histology and simple steatosis). Clinical and biochemical parameters were obtained from the patient databases and were compared between groups to identify preoperatively predictive factors of NASH.


RESULTS
From 51 patients, only one presented totally normal histology. Forty-three (86.2%) presented simple steatosis, and seven (13.7%) were classified as NASH. Clinical parameters were not different between groups. At biochemical analysis, only VLDL cholesterol level was significantly higher in the NASH group (p=0.037) but yet within the normal range. Association between macroscopic liver appearance and the presence of histological NASH is poor (sensitivity of 14%, specificity of 56%, positive predictive value of 5%, and negative predictive value of 80%).


CONCLUSIONS
No predictor of NASH was found. Surgeons' evaluation could not identify NASH individuals. Routine liver biopsy during bariatric operations is mandatory to differentiate NASH and nonalcoholic fatty liver disease.
Liver Transplantation Division, Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
Antônio Roberto Franchi
AR
Teixeira
Marta
M
Bellodi-Privato
José Barreto
JB
Carvalheira
Victor Fernando
VF
Pilla
José Carlos
JC
Pareja
Luiz Augusto Carneiro
LA
D'Albuquerque
D000328:Adult; D000704:Analysis of Variance; D050110:Bariatric Surgery; D001706:Biopsy; D001774:Blood Chemical Analysis; D015992:Body Mass Index; D005234:Fatty Liver / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome