Intraoperative liver biopsy during metabolic and bariatric surgery: diagnostic yield, safety, and national trends

Authors

• Hector J. Garcia Navas, LSU Health Sciences Center - New OrleansFollow
• Nicholas Dahlgren, LSU Health Sciences Center - New OrleansFollow
• Shubham Bhatia, LSU Health Sciences Center - New OrleansFollow
• Zubaidah Nor Hanipah, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, LA
• Carlos Galvani, LSU Health Sciences Center - New OrleansFollow
• Michael W. Cook, LSU Health Sciences Center - New OrleansFollow
• Denise M. Danos, LSU Health Sciences Center - New OrleansFollow
• Philip R. Schauer, LSU Health Sciences Center - New OrleansFollow
• Vance L. Albaugh, LSU Health Sciences Center - New OrleansFollow

Document Type

Article

Publication Date

7-17-2026

Publication Title

Surgery for Obesity and Related Diseases

Abstract

BACKGROUND: The reliability of noninvasive methods to detect metabolic dysfunction-associated steatotic liver disease and metabolic-associated steatohepatitis (MASH) or advanced liver disease remains uncertain. OBJECTIVES: To test the hypothesis that routine liver biopsy (LB) during metabolic and bariatric surgery (MBS) at an academic center would identify a high prevalence of MASH with minimal operative risk. SETTING: Single-center metabolic and bariatric surgery accreditation and quality improvement center in Louisiana and national metabolic and bariatric surgery accreditation and quality improvement data, 2020-2023. METHODS: Institutional and national MBS cases were analyzed. Patients aged < 18 years, open procedures, conversions/revisions, and missing biopsy results (institutional data) were excluded. LB characteristics and case outcomes were examined using logistic regression to determine the association of postoperative complications. RESULTS: A total of 980 institutional cases and 695,343 national cases were identified. Local routine LB prevalence was 48%, while national prevalence for LB was 3.5%. Routine LB locally revealed steatosis in 71.8%, nonalcoholic steatohepatitis in 31.6%, and fibrosis in 20.6%. Black race was associated with lower odds of steatosis (odds ratio [OR]: .34), MASH (OR: .28), and fibrosis (OR: .45). In contrast, hypertension (OR: 1.93) and insulin-dependent diabetes (OR: 2.66) were associated with increased nonalcoholic steatohepatitis risk. Postoperative complications were not different between routine LB and non-LB patients locally (P > .05). Cases with LB nationally had slightly lower estimates of complications, although small but significant differences were observed with the larger sample. CONCLUSIONS: Metabolic dysfunction-associated steatotic liver disease/MASH is highly prevalent in MBS. Not only is LB safe and not risk prohibitive but it also identifies advanced liver disease that is generally poorly detected preoperatively and can affect postoperative treatment and outcomes.

First Page

1

Last Page

10

PubMed ID

42567775

Rights

©2026 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc.

Recommended Citation

Garcia Navas, Hector J.; Dahlgren, Nicholas; Bhatia, Shubham; Hanipah, Zubaidah Nor; Galvani, Carlos; Cook, Michael W.; Danos, Denise M.; Schauer, Philip R.; and Albaugh, Vance L., "Intraoperative liver biopsy during metabolic and bariatric surgery: diagnostic yield, safety, and national trends" (2026). School of Medicine Faculty Publications. 5025.
https://digitalscholar.lsuhsc.edu/som_facpubs/5025
10.1016/j.soard.2026.07.009