Benefit-risk of intraoperative liver biopsy during bariatric surgery: review and perspectives

The aim of this systematic review was to determine the prevalence of NASH in patients with obesity undergoing bariatric surgery, the performance of noninvasive markers of NASH and complications of intraoperative liver biopsy. Meta-analysis found an overall NASH prevalence of .25 (95% confidence interval, .12-.39), with a high level of heterogeneity (I2 = 97%) across studies. The review showed that each noninvasive marker alone was unable to discriminate between patients with a normal liver and others. Conversely, intraoperative biopsy was related to some complications. Results from a clinical practices questionnaire in specialized centers for obesity care in France showed a large degree of heterogeneity. A prospective study would be interesting to evaluate an algorithm based on noninvasive markers for clinical decision making to determine the pertinence of liver biopsy during bariatric surgery.