The Use of Transient Elastography Technology in the Bariatric Patient: a Review of the Literature

Puthenpura, Max; Patel, Vishal; Fam, John; Katz, Leon; Tichansky, David S.; Myers, Stephan R.

doi:10.1007/s11695-020-05002-4

Cited by 3 publications

(5 citation statements)

References 76 publications

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“…Using the Fibroscan XL probe and an experienced operator we had a high success rate of 88% at baseline pre-op and 100% at follow-up, even with mean BMI in these groups being 40.2 and 28.7, respectively. A number of recent reports using the XL probe have shown similar high success rates [15][16][17][18] confirming the utility of transient elastography even in extreme obesity. Fibroscan failure is almost always caused by excess subcutaneous fat overlying the right chest wall which increases the skin to liver capsule distance 10,19 .…”

Section: Discussionmentioning

confidence: 74%

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Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

Yang

Nguyen

et al. 2021

Sci Rep

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Significant weight loss can modify the progression of Nonalcoholic fatty liver disease (NAFLD) with the most convincing evidence coming from bariatric surgery cohorts. Effective ways to non-invasively characterise NAFLD in these patients has been lacking, with high Fibroscan failure rates reported. We prospectively evaluated the utility of Fibroscan using XL-probe over a two-year period. 190 consecutive patients undergoing bariatric surgery were followed as part of their routine care. All patients had Fibroscan performed on the day of surgery and at follow-up a mean of 13 months (± 6.3) later. The majority of patients were female (82%) with mean age of 42. Fibroscan was successful in 167 (88%) at baseline and 100% at follow up. Patients with a failed Fibroscan had higher body mass index (BMI) and alanine transaminase (ALT), but no difference in FIB-4/NAFLD score. Mean baseline Liver stiffness measurement was 5.1 kPa, with 87% of patients classified as no fibrosis and 4% as advanced fibrosis. Mean baseline controlled attenuation parameter was 291, with 78% having significant steatosis, 56% of which was moderate-severe. Significant fibrosis was associated with higher BMI and HbA1c. Significant steatosis was associated with higher BMI, ALT, triglycerides and insulin resistance. Mean follow up time was 12 months with weight loss of 25.7% and BMI reduction of 10.4 kg/m2. Seventy patients had repeat fibroscan with reductions in steatosis seen in 90% and fibrosis in 67%. Sixty-four percent had complete resolution of steatosis. Fibroscan can be performed reliably in bariatric cohorts and is useful at baseline and follow-up. Significant steatosis, but not fibrosis was seen in this cohort with substantial improvements post-surgery.

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Section: Discussionmentioning

confidence: 74%

“…Fibroscan has previously been considered difficult in a morbidly obese population with unreliable results or scan failure in up to 50% of patients 10,15 . This has led to higher rates of liver biopsy than may be necessary.…”

Section: Discussionmentioning

confidence: 99%

Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

Yang

Nguyen

et al. 2021

Sci Rep

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“…Undoubtedly, LSM using TE is one of the most accurate and validated tools for evaluation of patients with chronic liver disease. In patients with morbid obesity complicated by NAFLD/NASH, TE has been shown to be a reliable method for quantifying liver fibrosis [ 16 ]. However, the previous studies included patients with a wide range of BMI.…”

Section: Discussionmentioning

confidence: 99%

“…One study in patients with obesity reported a TE failure rate of only 1.1%, using the XL probe, compared to 16% failure rate using the M probe [ 15 ]. Later, several studies examined the utility of TE in patients with obesity undergoing bariatric surgery and reported high accuracy of TE in discriminating between non-advanced and advanced fibrosis comparable to that of the gold standard liver biopsy [ 16 ]. However, there are factors other than BMI that can influence the LSM in patients with obesity.…”

Section: Introductionmentioning

confidence: 99%

The Utility and Diagnostic Accuracy of Transient Elastography in Adults with Morbid Obesity: A Prospective Study

Ali

Juboori

Petroski

et al. 2022

JCM

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Patients with morbid obesity are at high risk for nonalcoholic fatty liver disease (NAFLD) complicated by liver fibrosis. The clinical utility of transient elastography (TE) by Fibroscan in patients with morbid obesity (body mass index (BMI) ≥ 40 kg/m2) is not well-defined. We examined the diagnostic accuracy of Fibroscan in predicting significant liver fibrosis (fibrosis stage ≥2) in morbidly obese patients (BMI ≥ 40 kg/m2). Patients scheduled for bariatric surgery were prospectively enrolled. Intraoperative liver biopsy, liver-stiffness measurement (LSM) by Fibroscan (XL probe), and biochemical evaluation were all performed on the same day. The endpoint was significant liver fibrosis defined as fibrosis stage ≥2 based on the Nonalcoholic Steatohepatitis Clinical Research Network. The optimal LSM cutoff value for detecting significant fibrosis was determined by using the Youden Index method. Routine clinical, laboratory, and elastography data were analyzed by stepwise logistic regression analysis to identify predictors of significant liver fibrosis and build a predictive model. An optimal cutoff point of the new model’s regression formula for predicting significant fibrosis was determined by using the Youden index method. One hundred sixty-seven patients (mean age, 46.4 years) were included, of whom 83.2% were female. Histological assessment revealed the prevalence of steatohepatitis and significant fibrosis of 40.7% and 11.4%, respectively. The median LSM was found to be significantly higher in the significant fibrosis group compared to those in the no or non-significant fibrosis group (18.2 vs. 7.7 kPa, respectively; p = 0.0004). The optimal LSM cutoff for predicting significant fibrosis was 12.8 kPa, with an accuracy of 71.3%, sensitivity of 73.7%, specificity of 70.9%, positive predictive value of 24.6%, negative predictive value of 95.5%, and ROC area of 0.723 (95% CI: 0.62–0.83). Logistic regression analysis identified three independent predictors of significant fibrosis: LSM, hemoglobin A1c, and alkaline phosphatase. A risk score was developed by using these three variables. At an optimal cutoff value of the regression formula, the risk score had an accuracy of 79.6% for predicting significant fibrosis, sensitivity of 89.5%, specificity of 78.4%, positive predictive value of 34.7%, negative predictive value of 98.3%, and ROC area of 0.855 (95% CI: 0.76–0.95). Fibroscan utility in predicting significant liver fibrosis in morbidly obese subjects is limited with accuracy of 71.3%. A model incorporating hemoglobin A1c and alkaline phosphatase with LSM improves accuracy in detecting significant fibrosis in this patient population.

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“…Their usefulness in detecting fibrosis before surgery requires validation in more extensive studies. Transient elastography, two-dimensional shear wave elastography, and acoustic radiation force impulse shear wave imaging reliably predicted advanced fibrosis in bariatric candidates in small studies[ 167 - 169 ]. Three-dimensional magnetic resonance elastography is a promising modality to detect NASH and has demonstrated a sensitivity of 67% and specificity of 80%[ 170 ].…”

Section: Hepatic Evaluationmentioning

confidence: 99%

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

Bhattacharya¹,

Kalra²,

Kapoor³

et al. 2021

WJD

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Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.

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The Use of Transient Elastography Technology in the Bariatric Patient: a Review of the Literature

Cited by 3 publications

References 76 publications

Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

The Utility and Diagnostic Accuracy of Transient Elastography in Adults with Morbid Obesity: A Prospective Study

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

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