ABSTRACT: BackgroundNonalcoholic steatohepatitis (NASH) is a morbid condition highly related to obesity. It is unclear if the macroscopic liver
appearance correlates with the histopathologic findings. The goal of this prospective study was to determine the relationship
between the intraoperative liver appearance and the histopathologic diagnosis of NASH in morbidly obese subjects undergoing
bariatric surgery. We also aimed to determine variables that could predict NASH preoperatively.
MethodsConsecutive 51 subjects undergoing bariatric surgery without evidence of other liver disease underwent intraoperative liver
biopsy. An intraoperative liver visual (macroscopic and tactile examination) was recorded. The liver aspect was compared with
the liver histologic findings. Histological assessment was categorized into two groups: NASH and non-NASH (including normal
histology and simple steatosis). Clinical and biochemical parameters were obtained from the patient databases and were compared
between groups to identify preoperatively predictive factors of NASH.
ResultsFrom 51 patients, only one presented totally normal histology. Forty-three (86.2%) presented simple steatosis, and seven (13.7%)
were classified as NASH. Clinical parameters were not different between groups. At biochemical analysis, only VLDL cholesterol
level was significantly higher in the NASH group (p = 0.037) but yet within the normal range. Association between macroscopic liver appearance and the presence of histological
NASH is poor (sensitivity of 14%, specificity of 56%, positive predictive value of 5%, and negative predictive value of 80%).
ConclusionsNo predictor of NASH was found. Surgeons’ evaluation could not identify NASH individuals. Routine liver biopsy during bariatric
operations is mandatory to differentiate NASH and nonalcoholic fatty liver disease.
Obesity Surgery 04/2012; 19(12):1678-1684. · 3.29 Impact Factor