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

Abstract

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.