Postoperative FIB-4 Trajectories by Biopsy-Confirmed Fibrosis Stage After Sleeve Gastrectomy: An Exploratory Biopsy-Based Cohort Study.

INTRODUCTION

Whether advanced histological liver fibrosis limits postoperative improvement in fibrosis-related biomarkers after laparoscopic sleeve gastrectomy (LSG) remains unclear. We evaluated the fibrosis-related biomarker dynamics using biopsy-confirmed staging.

METHODS

This retrospective study included 74 patients who had undergone LSG with intraoperative liver biopsy. Fibrosis was staged using the Brunt classification and patients were stratified into the F0-2 (n = 64) and F3-4 (n = 10) groups. Changes in the Fibrosis-4 (FIB-4) index from baseline to 1 year postoperatively were assessed. The proportion of patients with FIB-4 ≥ 1.3 was analyzed. An exploratory analysis of covariance was performed among 41 patients with baseline diabetes to identify predictors of 1-year FIB-4.

RESULTS

The baseline FIB-4 was significantly higher in the F3-4 than in the F0-2 group (median 1.593 vs. 0.847, p = 0.026). At 1 year, the FIB-4 values did not differ significantly between the two groups (0.853 vs. 0.857, p = 0.433). The proportion of patients with FIB-4 ≥ 1.3 decreased from 60 to 20% in the F3-4 group and from 12.5 to 7.8% in the F0-2 group. Postoperative %total weight loss (%TWL), diabetes remission, HbA1c, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels did not differ between groups. In an exploratory multivariable analysis of 41 patients with baseline diabetes, baseline FIB-4 was significantly associated with 1-year FIB-4 (unstandardized β = 0.472, p < 0.001), whereas fibrosis stage was not statistically significant.

CONCLUSIONS

These findings suggest that favorable changes in fibrosis-related biomarkers may occur after LSG even among patients with histologically advanced fibrosis. However, these observations should be considered exploratory and require confirmation in larger cohorts.

KEY POINTS: • How severe liver fibrosis affects fibrosis-related risk after LSG remained unclear. • We evaluated the fibrosis-related biomarker dynamics using biopsy-confirmed staging. • The FIB-4 index decreased after LSG in patients with advanced fibrosis, and no significant difference in FIB-4 was detected between the fibrosis groups at 1 year. • The favorable changes in fibrosis-related risk markers may occur after LSG even among patients with histologically advanced fibrosis.