426 Missed Opportunities in Managing Steatotic Liver Disease in Upper GI Surgical Patients: A Review of Liver Shrinking Diet Use and Long-Term Advice

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Abstract Background The increasing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) presents growing challenges in upper gastrointestinal (UGI) surgery. A pre-operative liver shrinking diet (LSD) can reduce liver size, potentially making procedures easier, quicker, and safer. Additionally, the long-term implications of MASLD should be addressed with patients. However, pathways for identifying and managing these patients remain inconsistent. We sought to assess current practice and identify areas for improvement. Method A retrospective review of 70 consecutive patients undergoing laparoscopic cholecystectomy over a 9-month period was performed. Data on BMI, admission type, surgical listing, use of LSD, and documentation of lifestyle or liver health advice were collected. Results Of 70 patients, 25 (36%) had a BMI ≥35, with 26 identified as having MASLD on imaging. An LSD was requested in only 12 cases (17%). Patients listed for urgent or elective surgery following unplanned admission (2/39) and those admitted under non-UGI specialties (0/22) were significantly less likely to receive an LSD. No documented advice was given regarding long-term MASLD management or cirrhosis prevention in any case. Conclusions Our current approach to perioperative liver optimisation is inconsistent, particularly in emergency and non-UGI admissions. Additionally, we are missing important opportunities to provide patients with advice on long-term liver health. Implementing a standardised pathway for LSD use and integrating routine MASLD management advice into surgical care could improve both perioperative outcomes and long-term patient health.