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Wedge and needle liver biopsies show discordant histopathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery

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Gastroenterology Report 2013年第1期1卷 51-57页

作者： Sekou R.Rawlins Cynthia M.Mullen Howard M.Simon Taewan kim steven k.landas Marguerite S.Walser Robert A.Levine Division of Gastroenterology Department of MedicineState University of New York(SUNY)Upstate Medical UniversitySyracuseNYUSA Associates in Gastroenterology RockvilleMDUSA Department of Surgery SUNYUpstate Medical UniversitySyracuseNYUSA Department of Pathology SUNYUpstate Medical UniversitySyracuseNYUSA Section of Gastroenterology Department of MedicineBoston University School of MedicineBostonMAUSA

Background:Controversy exists over whether or not single-needle liver biopsies are sufficient to compare histological parameters in patients with non-alcoholic fatty liver ***:To identify sampling variability,we biopsied four liver specimens per patient,based on biopsy size(needle vs wedge)and location(left vs right lobe),immediately prior to bariatric Roux-en-Y gastric bypass ***:Ten prospectively enrolled,morbidly obese patients underwent 40 laparoscopy-guided biopsies;two needle and two wedge from each of 16 left and 16 right liver *** kappa coefficient for concordance compared histological parameters from left and right lobe needle-and wedge *** biopsies were considered our‘Gold Standard’.Results:Each patient had two wedge-and two needle liver *** concordance between all needle and wedge biopsies from right and left lobes showed ***-and needle liver biopsies from contralateral lobes had higher concordance with each other,compared to ipsilateral needle/wedge biopsy *** wedge pairs had higher concordance than contralateral needle/needle *** were no biopsy ***:Wedge biopsy pairs had the best kappa concordance but contralateral needle/needle biopsy pairs had good kappa *** were no complications from the 40 needle-and wedge liver biopsies,confirming the safety of laporoscopic multi-biopsy in both liver lobes.

关键词： gastric bypass liver biopsy steatosis fibrosis image analysis

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