Abstract
Practitioners routinely perform intraoperative liver biopsies during laparoscopic sleeve gastrectomy (LSG) to evaluate nonalcoholic fatty liver disease (NAFLD). In some patients, hepatocyte ballooning, inflammation, and fibrosis without steatosis are observed, even in the absence of other etiologies. We call this finding indeterminable nonalcoholic steatohepatitis (Ind-NASH). In this study, we clarified the prevalence, as well as histopathological and clinical features, of Ind-NASH through intraoperative liver biopsy in Japanese patients presenting with severe obesity. We enrolled 63 patients who had undergone LSG and intraoperative liver biopsy. In patients diagnosed with histopathological NASH, we performed protocol liver biopsies at 6 and 12 months after LSG. We statistically analyzed these histopathological findings and clinical parameters and found the prevalence rate of Ind-NASH discovered through intraoperative biopsy to be 15.9%. Protocol liver biopsy also revealed that Ind-NASH was an intermediate condition between NASH and normal liver. The clinical features of patients with Ind-NASH are a higher body weight compared to NASH (134.9 kg vs. 114.7 kg; p = 0.0245), stronger insulin resistance compared to nonalcoholic fatty liver (homeostasis model assessment–insulin resistance: 7.1 vs. 4.9; p = 0.0188), and mild liver dysfunction compared to NASH. Patients with Ind-NASH observed positive weight-loss effects from a preoperative diet compared to the postoperative course (percentage total weight loss: 32.0% vs. 26.7%; p < 0.0001). Patients with Ind-NASH may also be good candidates for metabolic surgery owing to their good treatment response; therefore, efforts should be made by specialists in the near future to deeply discuss and define Ind-NASH.
Highlights
Using a prospectively registered database, we examined the following data collected at the first visit, 6 months after laparoscopic sleeve gastrectomy (LSG), and 12 months after LSG, with regard to diabetic parameters: fasting blood glucose (FBG), immunoreactive insulin (IRI), hemoglobin A1c (HbA1c), C-peptide, homeostatic model assessment of insulin resistance (HOMA-IR), and homeostasis model assessment for beta cell function (HOMA-β)
Intraoperative liver biopsy revealed that 35, 18, and 10 patients were diagnosed with nonalcoholic steatohepatitis (NASH), nonalcoholic fatty liver (NAFL), and Ind-NASH, respectively; we classified these patients into three groups (NASH, NAFL, and Ind-NASH)
Intraoperative and protocol liver biopsy revealed that Ind-NASH appeared in both cases, owing to preoperative and postoperative weight loss; in other words, preoperative diet and LSG reduced steatosis, but inflammation and/or fibrosis remained for a certain period
Summary
The incidence of nonalcoholic fatty liver disease (NAFLD) is rapidly increasing, and it is one of the most prevalent chronic liver diseases stemming from hepatic virus infection worldwide [1]. NAFLD has been recognized as resulting from an unhealthy lifestyle and a lack of daily exercise; NAFLD is associated with metabolic dysfunction such as obesity, type 2 diabetes (T2D), and metabolic syndrome [2]. NAFLD encompasses a spectrum of diagnoses, including simple steatosis, nonalcoholic steatohepatitis (NASH), liver cirrhosis, and hepatocellular carcinoma [3]. Obesity and increased body mass index (BMI)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
