Routine Liver Biopsy to Screen for Nonalcoholic Fatty Liver Disease (NAFLD) during Cholecystectomy for Gallstone Disease: Is it Justified? |
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Authors: | Antonio Ramos-De la Medina José M Remes-Troche Federico B Roesch-Dietlen Alfonso G Pérez-Morales Silvia Martinez Silvia Cid-Juarez |
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Institution: | (1) Gastroenterology and Gastrointestinal Surgery Department, Veracruz Regional Hospital, Veracruz, México;(2) Digestive Physiology and Motility Laboratory,Medical–Biological Research Institute, University of Veracruz, Iturbide S/N, Veracruz, CP 91910, Mexico;(3) University of Veracruz Medical School, Veracruz, México |
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Abstract: | Background Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) share common risk factors. There are no firm recommendations
regarding screening of NAFLD in patients at risk. Our aim was to assess the prevalence of and factors associated with NAFLD
in a cohort of patients operated for symptomatic GD and evaluate the usefulness of routine liver biopsy.
Methods Ninety-five consecutive patients underwent a liver biopsy at the end of a standard laparoscopic cholecystectomy for symptomatic
GD. Clinical, biochemical, demographic, and anthropometric variables were obtained prospectively.
Results Fifty-two patients (55%) had biopsies compatible with NAFLD. These patients were classified according to the system proposed
by Brunt et al. as follows: grade I, n = 27 (52%); grade II, n = 15 (29%); grade III, n = 10 (19%). Two grade III patients had zone III focal perisinusoidal fibrosis and three had overt cirrhosis. Only 13% of
subjects had a suspected diagnosis of NAFLD preoperatively. In multivariate logistic regression, only obesity was significantly
associated with NAFLD. There were no complications or mortality.
Discussion Fifty-five percent of patients with GD have associated NAFLD. Awareness of this association may result in an earlier diagnosis.
The high prevalence of NAFLD in patients with GD may justify routine liver biopsy during cholecystectomy to establish the
diagnosis, stage, and possible direct therapy.
This work was presented at the Plenary Session of the 2008 Society of Surgery of the Alimentary Tract meeting in San Diego,
CA, USA. |
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Keywords: | NAFLD Liver biopsy Gallstone disease Risk factors Screening Prevalence |
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