The diagnostic accuracy of transient elastography for the diagnosis of liver fibrosis in bariatric surgery candidates with suspected NAFLD.
BACKGROUND
Severe obesity and metabolic syndrome have been implicated in the development of nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic value of liver stiffness measurement (LSM), by transient elastography (FibroScan®) in bariatric surgery candidates with suspected NAFLD.


METHODS
A total of 100 prospectively included consecutive severely obese subjects underwent bariatric surgery with liver needle biopsy. LSM was performed in the 15 days preceding liver biopsy.


RESULTS
According to Kleiner's classification, 28 patients had no fibrosis, 50 had stage F1 fibrosis, 13 had stage F2 fibrosis, and nine had stage F3 fibrosis. LSMs were higher in patients with fibrosis stage F ≥2, than in patients with a fibrosis stage below F2 (p < 0.001). Fibrosis stage (p < 0.002), amount of steatosis (%) (p < 0.001), BMI (p < 0.02), and activity score (p = 0.027) were independently correlated with LSM. Homeostasis model assessment (HOMA) index was also significantly and independently correlated with LSM (p < 0.01). The area under the receiver operating characteristic curve (AUROC) generated by FibroScan® was 0.81 ± 0.05 for predicting fibrosis stage F ≥2 and 0.85 ± 0.04 for predicting F3 fibrosis. The decrease in LSM 1 year after bariatric surgery was significantly correlated with changes in HOMA index (r = 0.43, p = 0.01), but not with changes in BMI or weight.


CONCLUSIONS
FibroScan® allows the early diagnosis of fibrosis in severely obese patients. Our results also suggest that FibroScan® could identify a subgroup of NAFLD patients at high risk of progressive liver disease and that LSM could be used as a surrogate marker of insulin resistance. Further studies are required to evaluate the prognostic value of FibroScan®.
Service d'Hépato-gastroentérologie et Nutrition, AP-HP, Hôpital Antoine Béclère, 157 Rue de la Porte de Trivaux, Clamart, 92140, France, sylvie.naveau@abc.aphp.fr.
Sylvie
S
Naveau
Karima
K
Lamouri
Guillaume
G
Pourcher
Micheline
M
Njiké-Nakseu
Stefano
S
Ferretti
Rodi
R
Courie
Hadrien
H
Tranchart
Mariana
M
Ghinoiu
Axel
A
Balian
Sophie
S
Prévot
Gabriel
G
Perlemuter
Ibrahim
I
Dagher
D000328:Adult; D050110:Bariatric Surgery; D001706:Biopsy; D015992:Body Mass Index; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000175:diagnosis*; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011237:Predictive Value of Tests; D012372:ROC Curve