Routine Liver Biopsy During Bariatric Surgery: an Analysis of Evidence Base

Abstract

Non-alcoholic fatty liver disease and non-alcoholic steato-hepatitis are common in patients undergoing bariatric surgery. Non-alcoholic steato-hepatitis can progress to cirrhosis of the liver and hepatocellular carcinoma. Non-invasive methods of diagnosing non-alcoholic steato-hepatitis are not as accurate as liver biopsy, and bariatric surgery presents a unique opportunity to carry out a simultaneous liver biopsy. Routine liver biopsy can help early and accurate diagnosis of obesity-associated liver conditions. This has led some surgeons to argue for routine liver biopsy at the time of bariatric surgery. However, most bariatric surgeons remain unconvinced and liver biopsy is currently not routine practice with bariatric surgery. This review examines published scientific literature to ascertain the usefulness of routine liver biopsy at the time of bariatric surgery.

Keywords: Bariatric surgery; Cirrhosis; Gastric band; Gastric biopsy; Laparoscopic liver biopsy; Liver biopsy; Liver fibrosis; Non-alcoholic fatty liver disease; Non-alcoholic steato-hepatitis; Obesity surgery; Percutaneous liver biopsy; Sleeve gastrectomy.