Format

Send to

Choose Destination
Obes Surg. 2019 Aug 24. doi: 10.1007/s11695-019-04136-4. [Epub ahead of print]

Intraoperative Liver Biopsy During Adolescent Bariatric Surgery: Is It Really Necessary?

Author information

1
Department of Surgery, Division of Pediatric Surgery, Stanford University Medical Center, 300 Pasteur Dr Rm M116, Alway Bldg MC 5733, Stanford, CA, 94305, USA.
2
Department of Pediatrics, Division of Gastroenterology, Stanford University Medical Center, Stanford, CA, USA.
3
Department of Clinical Pathology, Stanford University Medical Center, Stanford, CA, USA.
4
Department of Surgery, Division of Pediatric Surgery, Stanford University Medical Center, 300 Pasteur Dr Rm M116, Alway Bldg MC 5733, Stanford, CA, 94305, USA. mbruzoni@stanford.edu.

Abstract

BACKGROUND:

Nonalcoholic fatty liver disease (NAFLD) is prevalent in children with obesity and is definitively diagnosed with liver biopsy. However, the utility of routine biopsy during adolescent bariatric surgery remains unknown. We describe the usefulness of routine versus selective intraoperative liver biopsy in adolescents undergoing bariatric surgery.

METHODS:

A retrospective review of adolescents who received bariatric surgery at our institution between 2007 and 2018 was performed. Prior to 2014, all patients routinely received intraoperative liver biopsy. After 2014, biopsy was performed selectively on an individual basis for transaminitis or clinical concern. Demographic, biochemical, and histopathologic data were compared between patients who underwent routine, selective, or no biopsy.

RESULTS:

There were 77 patients who received bariatric surgery during the study period: 32 underwent routine biopsy, 13 selective biopsy, and 32 no biopsy. Selective liver biopsy was more likely to show pathologic evidence of fibrosis (84.6% versus 31.2%, p = 0.000) and steatosis (100.0% versus 59.4%, p = 0.003), and higher mean NAFLD activity score compared with routine biopsies (4.4 versus 2.1, p = 0.001). Patients with steatosis had significantly higher preoperative fasting insulin (41.4 versus 21.1 mIU/L, p = 0.000), and patients with fibrosis had significantly higher glycated hemoglobin (6.1% versus 5.5%, p = 0.033) and alanine aminotransferase (81.5 versus 52.7 mg/dL, p = 0.043). There were no biopsy complications or changes in management due to biopsy results.

CONCLUSIONS:

Routine intraoperative liver biopsy during adolescent bariatric surgery possesses questionable benefit, as it does not appear to impact short-term postoperative management. Prospective, longitudinal studies are needed to better understand the meaningfulness of liver histopathology in this population.

KEYWORDS:

Adolescent; Bariatric surgery; Liver biopsy; Nonalcoholic fatty liver disease; Nonalcoholic steatohepatitis; Utility

PMID:
31446562
DOI:
10.1007/s11695-019-04136-4

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center