Background:
Type 2 diabetes (T2D) is a risk factor for non-alcoholic fatty liver disease (NAFLD), the most common cause of chronic liver disease, cirrhosis and hepatocellular carcinoma. Transient elastography (TE) is a well stablished non-invasive method for diagnosis of liver steatosis and fibrosis.
AIMS: To evaluate, with transient elastography (TE), the effect of laparoscopic selective intra-abdominal sympathectomy associated to a duodenal ileal interposition and sleeve gastrectomy for the treatment of TD2 on NAFLD.
Methods:
 TE was performed with Fibroscan® on the right lobe of the liver through intercostal spaces, according to quality criteria determined by the manufacturer. Measurements were performed with M and XL probes. Baseline anthropometric data, laboratory parameters, liver stiffness measurement (LSM) and Controlled Attenuation Parameter (CAP) were collected from enrolled patients in clinical trial NCT03333642. LSM and CAP values were obtained at baseline and six months after surgery. 
Results:
Of the 11 patients enrolled, seven were female and four were male. Mean BMI was 30 kg/m2 (26.6-34.5) and mean duration of T2D  was 10.6 years (3-23). Mean glycated haemoglobin (HbA1c) was 10% (7.5-14.6) and 8 (72%) patients were on insulin. TE measurements were available in all patients. The median LSM and CAP were 8.6 (3-24.8) kPa and 292.2 dB/m, respectively. TE revealed no fibrosis (F0) in 8(72%) patients, moderate fibrosis (F2) in 1(9%) and advanced fibrosis (F4) in 2(18%). CAP revealed mild steatosis in 4(36%) patients, moderate steatosis in 2(18%) and severe steatosis in 5(46%).At the 6-month follow-up there was an improvement in hepatic steatosis and liver fibrosis, according to CAP and LSM.
Conclusions:  Laparoscopic selective intra-abdominal sympathectomy associated to a duodenal ileal interposition and sleeve gastrectomy may improve liver stiffness and steatosis in TD2 patients with concomitant NAFLD.

FIBROSCAN SCREENING OF DIABETIC PATIENTS WITH A BMI&lt; 35 kg/m2 SUBMITTED TO LAPAROSCOPIC SELECTIVE INTRA-ABDOMINAL SYMPATHECTOMY ASSOCIATED WITH A DUODENUM ILEAL INTERPOSITION AND SLEEVE GASTRECTOMY

FIBROSCAN SCREENING OF DIABETIC PATIENTS WITH A BMI&lt; 35 kg/m2 SUBMITTED TO LAPAROSCOPIC SELECTIVE INTRA-ABDOMINAL SYMPATHECTOMY ASSOCIATED WITH A DUODENUM ILEAL INTERPOSITION AND SLEEVE GASTRECTOMY

FIBROSCAN SCREENING OF DIABETIC PATIENTS WITH A BMI< 35 kg/m2 SUBMITTED TO LAPAROSCOPIC SELECTIVE INTRA-ABDOMINAL SYMPATHECTOMY ASSOCIATED WITH A DUODENUM ILEAL INTERPOSITION AND SLEEVE GASTRECTOMY