P2431 - Prevalence of Non-Alcoholic Steatohepatitis in Patients with Cholelithiasis and Fatty Liver: Is Routine Liver Biopsy Necessary?

Utpal Anand, MBBS, MS, Aaron John, MBBS, MS, Tarun Kumar, MBBS, MD
All India Institute of Medical Sciences, Patna, Bihar, India

Introduction: Gallstone disease (GSD) and non-alcoholic fatty liver disease (NAFLD) shares the same risk factors. NAFLD characterized by the fatty infiltration of hepatic parenchyma, can progress to non-alcoholic steatohepatitis (NASH) which in turn can progress to more severe forms of liver disease including cirrhosis and hepatocellular carcinoma. We aimed to assess the prevalence of NASH and factors associated with NASH in patients with GSD and fatty liver undergoing cholecystectomy.

Methods: 134 patients having GSD and fatty liver on preoperative ultrasound underwent core biopsy from the liver during cholecystectomy. Preoperatively clinical, anthropometric, demographic, and biochemical variables and fibro scan were documented.

Results: NASH was found in 21 (15.67%) patients. Fifty (37.31%) patients, had probable NASH, and 63 (47.01%) had non-NASH scores. Metabolic syndrome was present in 63.6%. On univariate analysis, AST (aspartate aminotransferase) and ALT (alanine transaminase) levels were significantly different between the NASH and non-NASH groups. In multivariate analysis, AST was statistically significant (p = 0.041). The mean CAP (Controlled Attenuation Parameter) in patients with non-NASH was 219.40 ± 60.44 dB/m, and in patients with NASH was 265.48 ± 63.47 dB/m (p = 0.006). Fibrosis was present in 33 of the 82 slides examined, with 17 patients having grade 2 and 2 patients with grade 3 fibrosis. There were no complications or mortality.

Discussion: The incidence of NASH in 15.67% of patients in our study, is similar to previous studies, although no previous study has specifically assessed the prevalence of NASH in GSD patients with ultrasound-proven fatty liver. NASH patients had a higher incidence of obesity, metabolic syndrome, and dyslipidemia though this failed to achieve statistical significance. Patients with NASH had greater derangement in liver enzymes than non-NASH subjects and this was statistically significant on univariate analysis. CAP a marker of hepatic steatosis was found to be significantly raised in the NASH group. An elevated CAP, and altered liver enzymes (AST, ALT) imply a greater risk for NASH according to our study.

In conclusion, the high prevalence of NASH among GSD patients raises significant public health concerns. In NAFLD patients with GSD undergoing laparoscopic cholecystectomy, particularly those with elevated liver enzymes; a liver biopsy is advisable.


Disclosures:


Utpal Anand, MBBS, MS, Aaron John, MBBS, MS, Tarun Kumar, MBBS, MD. P2431 - Prevalence of Non-Alcoholic Steatohepatitis in Patients with Cholelithiasis and Fatty Liver: Is Routine Liver Biopsy Necessary?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.