Assessment of hepatic steatosis before and after laparoscopic sleeve gastrectomy

Abstract

Background Nonalcoholic fatty liver disease (NAFLD) is the cause of the new epidemic of chronic liver disease. Most patients are asymptomatic and accidentally diagnosed by imaging. Unfortunately, NAFLD can progress to inflammation, NASH, fibrosis, cirrhosis, HCC, decompensated cirrhosis, death, and/or liver transplantation might be required. Laparoscopic sleeve gastrectomy (LSG) has positive effects on the comorbidities associated with obesity. FibroScan and controlled attenuation parameter (CAP) can assess NAFLD non-invasively by measuring an area a hundred times larger than a biopsy sample. Aim To assess hepatic steatosis pre and post LSG by laboratory investigations and imaging (fibroscan and CAP). Methods Thirty patients were included in a prospective observational study according to the inclusion criteria. Full medical history, preoperative laboratory investigations and imaging were recorded. All patients underwent LSG and were followed up for 6 months postoperatively. Data were coded and analysed by using (SPSS) version 29. Results LSG was associated with a significant improvement in the controlled attenuation parameter CAP values, stiffness values and accordingly grades of steatosis and fibrosis as well as a highly significant decrease in BMI, and on follow-up fibroscan 6 months postoperatively. There was a significant improvement in total cholesterol, triglycerides, LDL and HDL. Conclusion LSG is associated with a significant improvement in BMI, lipid profile, CAP measurement and liver stiffness measurements which means improvement of steatosis. In morbidly obese candidates of bariatric surgery, Fibroscan with CAP (using the XL probe) was used as a simple non-invasive tool for detecting steatosis and fibrosis.