EASL Campus

A 48-year-old male is referred to the hepatology outpatient clinic in the course of workup for bariatric surgery. The patient has elevated liver enzymes (AST 84 U/L (ULN: 50), 96 U/L (ULN: 50), and GGT 168 U/L (ULN: 60)); ALP is normal. The serum bilirubin level (0.91 mg/dL), albumin (3.8 g/dL), and INR (1) are normal, the platelet count is 156 G/L. The patient is overweight (134 kg) with a BMI of 41.35 and is taking metformin for type 2 diabetes mellitus as well as amlodipine for arterial hypertension. The patient has no history of alcohol use disorder and has completely abstained from alcohol for 2 years, when cirrhosis due to MASH was diagnosed by liver biopsy. Ultrasound indicates steatosis, a nodular liver surface, no portal vein thrombosis, a spleen size of 13cm, and no evidence of portosystemic shunts. A recent esophagogastroduodenoscopy found no varices.

Which combination of assessment(s) and clinical conclusion is the most appropriate?

A. Since the patient is compensated and has preserved liver function (Child-Turcotte-Pugh A), no further preoperative assessments are required. From the hepatology perspective, the patient deemed fit for bariatric surgery of any type.

B. Besides the calculation of the VOCAL-Penn score, no further workup is needed. The conclusion is based on the respective estimated risk.

C. Besides the calculation of the VOCAL-Penn score, non-invasive tests to estimate the probability of clinically significant portal hypertension should be applied as part of multimodal risk assessment. The conclusion is based on the respective results.

D. No further assessments are required and the patient should be evaluated for preoperative transjugular portosystemic shunt placement.

E. No further workup is required, as bariatric surgery is generally contraindicated in compensated advanced chronic liver disease.

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