Hepatic Steatosis Clinical Trial
Official title:
A Prospective Study for the Effect of Cholecystectomy to the Liver in Consideration of Hepatic Steatosis 3months After Cholecystectomy With Ultrasound
The investigators are very pleased to register the study entitled "A prospective study for
the effect of cholecystectomy to the liver in consideration of hepatic steatosis 3months
after cholecystectomy with Ultrasound".
This study deals with prospective ultrasound study about hepatic steatosis development 3
months after cholecystectomy. This study was approved by the Institutional Review Board of
the local institute. From Oct, 2013 to Jul, 2014, assessment of liver changes after
cholecystectomy was carried out in 82 patients with gallbladder disease. In conclusion, the
investigators thought that cholecystectomy might be considered as a risk factor for hepatic
steatosis.
All subjects underwent a complete medical history and physi¬cal examination. Physical
examination included measurements of height and weight. Subjects with a body mass index
(BMI) ≥ 30 kg/m2 were considered obese. Laboratory tests included white blood cell (WBC)
count, serum albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine
aminotransferase (ALT), total bilirubin, amylase, lipase, total cholesterol, triglycerides
(TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol
(LDL-C), and high-sensitivity C-reactive protein (hsCRP).
In order to analyze the presence and severity of hepatic steatosis, hepatic steatosis index
(HSI), US and liver biopsy was used. The hepatic steatosis index (HSI) was calculated as 8 ×
ALT/AST + BMI +2 (if diabetes) +2 (if female gender). All patients underwent US at the time
of operation and 3 months postoperatively. All US procedures were performed by one
board-certified radiologist who did not have information about the patients. Procedures were
done using an iU22 apparatus (Philips Ultrasound, Bothell, WA, USA) or an EUB-7500 apparatus
(Hitachi, Tokyo, Japan) equipped with a 5 MHz convex transducer. For evaluation of fatty
liver, the severity of liver echogenicity was categorized. Normal echogenicity was a mild
and slightly diffuse increase in hepatic echogenicity with normal visualization of diaphragm
and intrahepatic vessels. Moderate echogenicity was a moderately diffuse increase in hepatic
echogenicity with slightly impaired visualization of diaphragm and intrahepatic vessels.
Severe echogenicity was a marked increase in hepatic echogenicity with poor or
nonvisualization of the intrahepatic vessel borders, diaphragm, and posterior segment of the
right hepatic lobe.
Each US image was reread by the same radiologist who was blinded to the initial reading 1
month after the initial assessment to assess intraobserver variability. Liver biopsy was
performed during cholecystectomy using liver wedge resection in 10 patients who had provided
informed consent preoperatively. All specimens were reviewed by two pathologists with single
blinded method. Sections were stained with hematoxylin and eosin (H&E) and examined at X40
magnification. Steatosis was divided into four stages using the Brunt criteria.
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