Estudo descritivo de alterações histológicas em biópsias hepáticas em pacientes submetidos a gastrectomia vertical

Abstract

Background - Obesity is the second cause of preventable deaths in the world and among the clinical conditions associated with morbidity and mortality a high frequency of non-alcoholic fatty liver disease and steatohepatitis non-alcoholic hepatitis is observed. Since laparoscopic sleeve gastrectomy has been proposed as a safe and efficient option, it is important that an evaluation of the hepatic tissue be performed before the procedure for comparison with future biopsies. Objective - The aim of this study is to analyze histological features in liver biopsies from patients submitted to sleeve gastrectomy. Methods - 32 patients (14 males and 18 females) were selected from a five years retrospective search of the files from a private pathology laboratory. Histological slides were reviwed with hematoxylin and eosin (HE) and stains for collagen (Masson’s Trichrome), reticulin fibers and iron deposit (Perls). Grading of hepatic steatosis, inflammatory activity and staging of fibrosis were performed using the classification proposed by Brunt and modified by NAS CRN later. Results – Non alcoholic steato-hepatitis (NASH) was detectd in all cases. The observed frequencies were: steatosis grade - 0: 9,37%; 1: 18,75%; 2: 37,5%; 3: 34,37%, lobular inflammation - 0: 3,1%; 1: 75%; 2: 18,75%; 3: 3,1%, hepatocyte balooning - 1: 15,65%; 2: 84,3%, inflammatory activity score: 4: 34,4%; > de 4: 65,6%, Fibrosis - 0: 25%, 1a: 43,8%, 1b: 3,1%, 1c: 6,2%, 2: 15,7%, 3: 3,1%, 4: 3,1%. Conclusion – NASH was detected in all sample and most cases disclosed hepatic fibrosis. Also, structural lesions (septal fibrosis, nodules and cirrhosis) were observed in 22% of the cases. These data reinforces the necessity of histological analysis in obese patients.