ACCURACY OF ELASTOGRAPHY IN THE ASSESSMENT OF REDUCTION IN LIVER STEATOSIS AND FIBROSIS IN THE EARLY POSTOPERATIVE PERIOD AFTER BARIATRIC SURGERY.

BACKGROUND: Nonalcoholic hepatic steatosis is found in most obese patients and has a strong association with metabolic syndrome. The Roux-en-Y gastric bypass and the sleeve gastrectomy are the two techniques of bariatric surgery. Patients who underwent bariatric surgery have regression of nonalcoholic steatohepatitis due to a reduction in body mass index and changes in incretin hormones. AIMS: This study aimed to analyze the acuity of elastography in the regression of hepatic steatosis and fibrosis in obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy 2 months after surgery. METHODS: Patients in the preoperative period of bariatric surgery underwent an anthropometric evaluation and hepatic elastography to quantify fibrosis and hepatic steatosis. Two months after surgery, the same evaluation was performed again. RESULTS: All 17 patients who met the inclusion criteria participated in the study. Out of this, nine underwent sleeve gastrectomy, and eight underwent Roux-en-Y gastric bypass. The Roux-en-Y gastric bypass group had lower fibrosis levels postoperatively compared to preoperatively (p=0.029, p<0.05). As for steatosis, patients who underwent Roux-en-Y gastric bypass had lower postoperative values (p=0.01, p<0.05). There was also a reduction in fibrosis postoperatively in the sleeve gastrectomy group compared to preoperatively (p=0.037, p<0.05). CONCLUSIONS: Elastography accurately demonstrated decreased hepatic steatosis and fibrosis in the early postoperative period of bariatric surgery. Moreover, Roux-en-Y gastric bypass and sleeve gastrectomy are suitable surgical methods to improve hepatic steatosis and fibrosis within 2 months postoperatively.

Accuracy of elastography in the assessment of reduction in liver steatosis and fibrosis in the early postoperative period after bariatric surgery / Acuidade da elastografia na avaliação da redução da esteatose e fibrose hepáticas no pós-operatório precoce pós cirurgia bariátrica

ABSTRACT BACKGROUND: Nonalcoholic hepatic steatosis is found in most obese patients and has a strong association with metabolic syndrome. The Roux-en-Y gastric bypass and the sleeve gastrectomy are the two techniques of bariatric surgery. Patients who underwent bariatric surgery have regression of nonalcoholic steatohepatitis due to a reduction in body mass index and changes in incretin hormones. AIMS: This study aimed to analyze the acuity of elastography in the regression of hepatic steatosis and fibrosis in obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy 2 months after surgery. METHODS: Patients in the preoperative period of bariatric surgery underwent an anthropometric evaluation and hepatic elastography to quantify fibrosis and hepatic steatosis. Two months after surgery, the same evaluation was performed again. RESULTS: All 17 patients who met the inclusion criteria participated in the study. Out of this, nine underwent sleeve gastrectomy, and eight underwent Roux-en-Y gastric bypass. The Roux-en-Y gastric bypass group had lower fibrosis levels postoperatively compared to preoperatively (p=0.029, p<0.05). As for steatosis, patients who underwent Roux-en-Y gastric bypass had lower postoperative values (p=0.01, p<0.05). There was also a reduction in fibrosis postoperatively in the sleeve gastrectomy group compared to preoperatively (p=0.037, p<0.05). CONCLUSIONS: Elastography accurately demonstrated decreased hepatic steatosis and fibrosis in the early postoperative period of bariatric surgery. Moreover, Roux-en-Y gastric bypass and sleeve gastrectomy are suitable surgical methods to improve hepatic steatosis and fibrosis within 2 months postoperatively.

RESUMO RACIONAL: A esteatose hepática não alcoólica é encontrada na maioria dos pacientes com obesidade e tem forte associação com a síndrome metabólica. O bypass gástrico em Y de Roux e a gastrectomia vertical são as duas técnicas de cirurgia bariátrica. Pacientes que são submetidos a cirurgia bariátrica tem regressão da esteatose hepática não alcoólica devido a redução do índice de massa corpórea e mudanças dos hormônios incretínicos. OBJETIVOS: analisar a acuidade da elastografia na regressão da esteatose e fibrose hepáticas em pacientes obesos submetidos a bypass gástrico em Y de Roux e gastrectomia vertical dois meses após a cirurgia. MÉTODOS: Pacientes em pré-operatório de cirurgia bariátrica foram submetidos a avaliação antropométrica e elastografia hepática para quantificação de fibrose e esteatose hepática. Dois meses após a cirurgia, a mesma avaliação foi realizada novamente. RESULTADOS: Dezessete pacientes preencheram todos os critérios de inclusão no estudo. Nove foram submetidos a gastrectomia vertical e 8 a bypass gástrico em Y de Roux. O grupo bypass gástrico em Y de Roux apresentou níveis de fibrose mais baixos no pós-operatório em comparação com o pré-operatório, (p=0,029, p<0,05). Quanto à esteatose, os pacientes que realizaram bypass gástrico em Y de Roux apresentaram valores menores no pós-operatório (p=0,01, p<0,05). No grupo gastrectomia vertical, também houve redução da fibrose no pós-operatório em relação ao pré-operatório (p=0,037, p<0,05). CONCLUSÕES: A elastografia mostrou acuidade para demonstrar diminuição da esteatose e fibrose hepáticas, no pós-operatório precoce de cirurgia bariátrica. Além disso, bypass gástrico em Y de Roux e gastrectomia vertical são métodos cirúrgicos adequados para melhorar a esteatose e fibrose hepática em um período de 2 meses de pós-operatório.