Alfonso Gerardo Pérez-Morales

Routine liver biopsy to screen for nonalcoholic fatty liver disease (NAFLD) during cholecystectomy for gallstone disease: is it justified?

BackgroundNonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) share common risk factors. There are no firm recommendations regarding screening of NAFLD in patients at risk. Our aim was to assess the prevalence of and factors associated with NAFLD in a cohort of patients operated for symptomatic GD and evaluate the usefulness of routine liver biopsy.MethodsNinety-five consecutive patients underwent a liver biopsy at the end of a standard laparoscopic cholecystectomy for symptomatic GD. Clinical, biochemical, demographic, and anthropometric variables were obtained prospectively.ResultsFifty-two patients (55%) had biopsies compatible with NAFLD. These patients were classified according to the system proposed by Brunt et al. as follows: grade I, n = 27 (52%); grade II, n = 15 (29%); grade III, n = 10 (19%). Two grade III patients had zone III focal perisinusoidal fibrosis and three had overt cirrhosis. Only 13% of subjects had a suspected diagnosis of NAFLD preoperatively. In multivariate logistic regression, only obesity was significantly associated with NAFLD. There were no complications or mortality.DiscussionFifty-five percent of patients with GD have associated NAFLD. Awareness of this association may result in an earlier diagnosis. The high prevalence of NAFLD in patients with GD may justify routine liver biopsy during cholecystectomy to establish the diagnosis, stage, and possible direct therapy.

Tu2051 Gallbladder Wall Changes in Patients With and Without Metabolic Syndrome

Background: Recent research has described that obesity and high carbohydrates intake increases fat content of the gallbladder, decreases its motility and mucosal absorption, leading to a condition known as steatocholecystitis. Gallstone disease (GD) and the metabolic syndrome (MS) share common risk factors. Objective: To identify if MS contributes to the development of functional disorders and wall changes of the gallbladder. Methods: A Prospective study was conducted from August 2010 to July 2011 on patients with symptomatic gallbladder disease undergoing laparoscopic cholecystectomy. Forty two patients were included and divided into two groups; 22 patients with MS and 20 patients without MS. Family history, risk factors, anthropometric, clinical and laboratory variables were evaluated before surgery. Gallbladder specimens were analyzed, measured and graded by two pathologists at 3 standardized areas (cystic duct, liver bed, free margin and fundus). Results: Thirty three patients who underwent cholecystectomy were female. A family history of GD and MS were present in 90% of patients. Chronic cholecystitis was the most frequent diagnostic (93%). Median weight was 75.5kg±14.3 and 67.1kg±9.2 for MS and No-MS groups respectively. Gallbladder wall thickness was significantly increased (P=0.012) in the MS group. This thickness was secondary mainly observed in the cystic duct area of patient with MS. The percentage of fatty infiltration of the gallbladder wall, muscle degeneration and cholesterolosis did not show significant differences between groups. Conclusions: MS is associated with an increased gallbladder wall thickness. Muscle fibrosis in the cystic duct was the most important wall modification in these patients. In our series, MS was not associated to fat infiltration of the gallbladder wall or cholesterolosis.