Assessment of Liver Health Before and After Bariatric Procedures: Current Status and Future Directions Within Endohepatology

Bariatric surgeries and endobariatric procedures are frequently performed as part of management of obesity, and many of these interventions have demonstrated benefit in reversal of commonly associated metabolic disorders, such as diabetes and liver fibrosis and steatosis. However, for patients with chronic liver disease, in particular those with cirrhosis and clinically significant portal hypertension, perioperative risk can be high. In this chapter, we review our understanding within the literature on the importance of preoperative liver screening, how we should screen patients for underlying liver disease, and how we can manage patients preoperatively to reduce morbidity and mortality post-intervention. In addition, we will review the role of three emerging endoscopic ultrasound (EUS) techniques that can supplement preprocedural upper endoscopies in relation to liver screening: EUS-guided liver biopsies, shear wave elastography, and portal pressure gradient measurements.