Routine Liver Biopsy to Screen for Nonalcoholic Fatty Liver Disease (NAFLD) during Cholecystectomy for Gallstone Disease: Is it Justified?

Medina, Antonio Ramos-De la; Troche, José María Remes; Roesch-Dietlen, F.; Pérez-Morales, Alfonso Gerardo; González-Martínez, Silvia; Cid-Juárez, Silvia

doi:10.1007/s11605-008-0704-7

Cited by 28 publications

(30 citation statements)

References 36 publications

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“…That the prevalence of NAFLD can further increase as the number of obese people in Asia increases is supported by the findings that 65 and 85% of subjects with a BMI of 30–40 and ≥40 kg/m 2 , respectively, had NAFLD [29]. Despite its high prevalence and potential impact, recent studies highlighted that, even among high-risk patients, 87% of people did not know they had NAFLD [30] and 51% of healthy potential liver donors were incidentally confirmed as having NAFLD by liver biopsy [31], indicating that alarming proportions of patients with NAFLD are unaware of their illness and are undiagnosed. Therefore, a simple risk score that can efficiently and effectively screen high-risk individuals for NAFLD in communities, as well as in clinical settings, could help improve personal and population health, and public awareness and education about this less known disease.…”

Section: Discussionmentioning

confidence: 95%

Non–Laboratory-Based Self-Assessment Screening Score for Non-Alcoholic Fatty Liver Disease: Development, Validation and Comparison with Other Scores

Lee

Bang

Park³

et al. 2014

PLoS ONE

107

110

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BackgroundNon-alcoholic fatty liver disease (NAFLD) is a prevalent and rapidly increasing disease worldwide; however, no widely accepted screening models to assess the risk of NAFLD are available. Therefore, we aimed to develop and validate a self-assessment score for NAFLD in the general population using two independent cohorts.MethodsThe development cohort comprised 15676 subjects (8313 males and 7363 females) who visited the National Health Insurance Service Ilsan Hospital in Korea in 2008–2010. Anthropometric, clinical, and laboratory data were examined during regular health check-ups and fatty liver diagnosed by abdominal ultrasound. Logistic regression analysis was conducted to determine predictors of prevalent NAFLD and to derive risk scores/models. We validated our models and compared them with other existing methods using an external cohort (N = 66868).ResultsThe simple self-assessment score consists of age, sex, waist circumference, body mass index, history of diabetes and dyslipidemia, alcohol intake, physical activity and menopause status, which are independently associated with NAFLD, and has a value of 0–15. A cut-off point of ≥8 defined 58% of males and 36% of females as being at high-risk of NAFLD, and yielded a sensitivity of 80% in men (77% in women), a specificity of 67% (81%), a positive predictive value of 72% (63%), a negative predictive value of 76% (89%) and an AUC of 0.82 (0.88). Comparable results were obtained using the validation dataset. The comprehensive NAFLD score, which includes additional laboratory parameters, has enhanced discrimination ability, with an AUC of 0.86 for males and 0.91 for females. Both simple and comprehensive NAFLD scores were significantly increased in subjects with higher fatty liver grades or severity of liver conditions (e.g., simple steatosis, steatohepatitis).ConclusionsThe new non–laboratory-based self-assessment score may be useful for identifying individuals at high-risk of NAFLD. Further studies are warranted to evaluate the utility and feasibility of the scores in various settings.

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Section: Discussionmentioning

confidence: 95%

Non–Laboratory-Based Self-Assessment Screening Score for Non-Alcoholic Fatty Liver Disease: Development, Validation and Comparison with Other Scores

Lee

Bang

Park³

et al. 2014

PLoS ONE

107

110

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“…Previous studies have shown that GD was a highly prevalent condition in NAFLD patients,15,16,17,18 and that it may represent an independent risk factor for NAFLD 19. In a large series of 524 Italian patients with biopsy-proven NAFLD, Fracanzani and colleagues demonstrated that the prevalence of GD progressively increased with advancing fibrosis and with the severity of necroinflammatory activity 20.…”

Section: Introductionmentioning

confidence: 99%

Gallstone Disease Does Not Predict Liver Histology in Nonalcoholic Fatty Liver Disease

et al. 2014

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Background/AimsWe sought to examine whether the presence of gallstone disease (GD) in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) is associated with liver fibrosis and histological nonalcoholic steatohepatitis (NASH) score.MethodsWe included 441 Turkish patients with biopsy-proven NAFLD. GD was diagnosed in the presence of sonographic evidence of gallstones, echogenic material within the gallbladder with constant shadowing and little or no visualization of the gallbladder or absence of gallbladder at ultrasonography, coupled with a history of cholecystectomy.ResultsFifty-four patients (12.2%) had GD (GD+ subjects). Compared with the GD- subjects, GD+ patients were older, had a higher body mass index and were more likely to be female and have metabolic syndrome. However, GD+ patients did not have a higher risk of advanced fibrosis or definite NASH on histology. After adjustment for potential confounding variables, the prevalence of GD in NAFLD patients was not associated with significant fibrosis (≥2) (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.53 to 2.21; p=0.68) or definite NASH (OR, 1.03; 95% CI, 0.495 to 2.12; p=0.84).ConclusionsThe presence of GD is not independently associated with advanced fibrosis and definite NASH in adult Turkish patients with biopsy-proven NAFLD.

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“…Additionally there have been various publications investigating an association between NAFLD and GD showing increased GD prevalence in NAFLD patients. [9][10][11][12][13][14] However there is no data available showing a causal relationship on this issue regarding gallbladder motility in patients with NAFLD. The present study was designed to investigate the relationship between fasting gallbladder volumes, ejection fraction, residual volume, gallbladder thickness, biochemical values, histopathological parameters, and anthropometric measurements in patients with biopsy-proven NAFLD without GD and healthy controls.…”

Section: Introductionmentioning

confidence: 99%

Impaired Gallbladder Motility and Increased Gallbladder Wall Thickness in Patients with Nonalcoholic Fatty Liver Disease

Çolak

Bozbey

Erim

et al. 2016

J Neurogastroenterol Motil

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Background/AimsNonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Along with the increase in the incidence of NAFLD and associated obesity, an increase in gallbladder disease (GD) has been noted. This has led to the identification of a new disease entity called fatty GD. There is a gap in the literature on the dynamics of gallbladder function in patients with NAFLD. MethodsAn observational case-control study, a total of 50 patients with biopsy proven NAFLD without gallbladder stone/sludge and 38 healthy comparison subjects were enrolled. Fasting, postprandial gallbladder volumes (PGV), gallbladder ejection fraction (GEF), and fasting gallbladder wall thickness (FGWT) were measured by real-time 2-dimensional ultrasonography. ResultsFasting gallbladder wall thickness, fasting gallbladder volumes and PGV were significantly higher in patients with NAFLD than control subjects (P < 0.001, P = 0.006, and P < 0.001, respectively). Gallbladder ejection fraction was significantly lower in the NAFLD group than the controls (P = 0.008). The presence of NAFLD was an independent predictor for GEF, PGV, and FGWT. Also, steatosis grade was an independent predictor for GEF, and GEF was significantly lower in the nonalcoholic steatohepatitis (NASH) subgroup than the controls. ConclusionsGallbladder dysfunction and increase in gallbladder wall thickness exists in asymptomatic (without stone/sludge and related symptoms) patients with NAFLD and are useful in identifying fatty GD. Measurement of these variables in NAFLD patients may be useful in identifying those at higher risk for GD.

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Routine Liver Biopsy to Screen for Nonalcoholic Fatty Liver Disease (NAFLD) during Cholecystectomy for Gallstone Disease: Is it Justified?

Cited by 28 publications

References 36 publications

Non–Laboratory-Based Self-Assessment Screening Score for Non-Alcoholic Fatty Liver Disease: Development, Validation and Comparison with Other Scores

Non–Laboratory-Based Self-Assessment Screening Score for Non-Alcoholic Fatty Liver Disease: Development, Validation and Comparison with Other Scores

Gallstone Disease Does Not Predict Liver Histology in Nonalcoholic Fatty Liver Disease

Impaired Gallbladder Motility and Increased Gallbladder Wall Thickness in Patients with Nonalcoholic Fatty Liver Disease

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