Universidade Federal Fluminense, Department of Specialized and General Surgery - Niterói (RJ), Brazil.
Universidade Federal Fluminense, Department of Clinical Medicine - Niterói (RJ), Brazil.
Arq Bras Cir Dig. 2024 Sep 2;37:e1821. doi: 10.1590/0102-6720202400028e1821. eCollection 2024.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease in the world and was recently renamed to emphasize its metabolic component.
This article seeks to fill the gap in specific guidelines for patients with obesity and MASLD who will undergo bariatric surgery.
A systematic search for guidelines was carried out on PubMed and Embase platforms.
A total of 544 articles were found, of which 11 were selected according to inclusion and exclusion criteria. All 11 guidelines are from clinical societies; therefore, they do not include some necessary interpretations for bariatric patients.
We recommend that every patient undergoing bariatric and metabolic surgery be screened initially with the Fibrosis-4 (FIB-4) score, followed by transient hepatic elastography (vibration-controlled transient elastography, VCTE), especially for those with FIB-4>1.3. However, interpreting VCTE results in obese patients requires further studies to define the actual cutoff values. Enhanced Liver Fibrosis® shows promise but its availability is limited. The indication for liver biopsy during surgery needs to be individualized but it is recommended for those with changes in FIB-4 and/or VCTE. Family screening is recommended for relatives of young patients with already advanced fibrosis. Liver transplantation is an option for patients with advanced MASLD but the optimal timing for bariatric surgery with transplantation is still unclear. Regular follow-up and VCTE examination are recommended to monitor disease progression after surgery.
代谢相关脂肪性肝病（MASLD）是世界上最常见的慢性肝病，最近更名为强调其代谢成分。
本文旨在为即将接受减重手术的肥胖合并 MASLD 患者填补特定指南的空白。
在 PubMed 和 Embase 平台上进行了系统的指南搜索。
共发现 544 篇文章，根据纳入和排除标准选择了 11 篇。所有 11 条指南均来自临床学会；因此，它们没有包括一些对减重患者必要的解释。
我们建议每个接受减重和代谢手术的患者最初都用 Fibrosis-4（FIB-4）评分进行筛查，然后进行瞬时肝弹性成像（振动控制瞬时弹性成像，VCTE），尤其是对于 FIB-4>1.3 的患者。然而，在肥胖患者中解释 VCTE 结果需要进一步研究来定义实际的截断值。enhanced Liver Fibrosis®显示出前景，但可用性有限。手术期间肝活检的指征需要个体化，但建议对 FIB-4 和/或 VCTE 改变的患者进行。建议对已经存在晚期纤维化的年轻患者的亲属进行家族筛查。肝移植是晚期 MASLD 患者的一种选择，但与肝移植联合进行减重手术的最佳时机仍不清楚。建议术后定期随访和 VCTE 检查以监测疾病进展。
