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General Liver I
PTU-028 Transient elastography in the risk stratification of patients with abnormal liver function tests
  1. E J Britton,
  2. R Saravanan,
  3. T Woodhouse,
  4. K Koss
  1. Department of Gastroenterology, Macclesfield District General Hospital, Macclesfield, UK

Abstract

Introduction Transient elastography (TE) (Fibroscan) is a well validated method for assessing liver fibrosis in a trial setting. Gastroenterology Department at Macclesfield DGH is one of the first centres in the UK to adopt Fibroscan examination into the diagnostic pathway of patients with abnormal LFT. This is the first publication of our data of unselected patients undergoing liver stiffness measurement (LSM) demonstrating practicalities and limitations of Fibroscan.

Methods Data were collected from 366 patients with abnormal LFT attending Gastroenterology Clinic from July 2010 to December 2011. Fibroscan examination was performed by two gastroentrology consultants and one specialist nurse. The cohorts of Fatty liver disease (FLD) and Alcoholic liver disease (ALD) were further analysed comparing fibrosis score from TE with clinical findings, laboratory blood tests, ultrasound imaging and liver biopsy.

Results Patients diagnosis were as follows: FLD 35.8% (n=131), ALD 14.8% (n=54), Chronic hepatitis C 15.6% (n=57), PSC/PBC 7.7% (n=28), chronic hepatitis B 4.6% (n=17), haemochromatosis 2.2% (n=8), AIH 1.4% (n=5), chronic usage of Methotrexate 1.9% (n=7). Additionally 42 healthy volunteers participated. The mean time duration for each successful scan was 173 (30–1363) seconds with 18% of patients requiring the XL probe due to central obesity. The fibrosis scores recorded for all patients scanned were F0-1 41% (n=150), F2 6.3% (n=23), F3 7.1% (n=26) and F4 26% (n=95). 15% of scans were considered to be failed as LSM/IQR was >33, most prevalent in the FLD group 16.8% (n=22) and wasn't operator or probe dependent. Significant proportion of patients with liver fibrosis (F3-4) had no clinical signs of chronic liver disease. 80% of patients F3-F4 fibrosis demonstrated portal hypertension on imaging and 32% of patients in that group had low platelets (3. The sensitivity and specificity of low platelets for significant fibrosis was 32% and 91% and for portal hypertension on imaging was 64% and 89% respectively. There was significant correlation between liver fibrosis scoring on TE and Metvir fibrosis scoring on biopsy in patients without high degree of inflammation. However, coexisting acute inflammation in some cases contributed to false positive results on Fibroscan.

Conclusion The Fibroscan technology has allowed rapid stratification of patients with chronic liver diseases. Significant proportion of patients (40%) were appropriately reassured without need of undergoing liver biopsy. 20% of patients without stigmata of chronic disease and without conventional laboratory markers of liver fibrosis were diagnosed with liver cirrhosis. Early experience has shown difficulties of performing TE in patients with central obesity and FLD. Fibroscan finds its valuable role in the care pathway of patients with abnormal LFT.

Competing interests None declared.

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