Introduction Transient Elastography (FibroScan®) is a well validated, easy to use, non-invasive method of assessing the stage of liver fibrosis, whilst avoiding potential complications of liver biopsy. Despite ease of use, operator success rates vary, there is a known failure rate and its accuracy at assessing the stage of fibrosis depends on a ‘valid’ reading being gained. The South West Liver Unit has been performing transient elastography since 2010 and receives referrals from regional hospitals where scanning is unavailable. The aim of this study was to review the overall numbers performed, the success rates of operators, and the percentage of valid scans obtained.
Methods Data was collected and analysed retrospectively; and was obtained from the FibroScan® hard drive. Clinical information was obtained from clinical databases and clinical letters. Validation of scan was based on the three recognised validation criteria; (1) >10 valid readings, (2) success rate > 60% and (3) interquartile range to median ratio of < 0.3.
Results Between 2010 and 2012 inclusive, 1819 scans were undertaken. Multiple attempts (n = 247), including probe size change, were excluded. Of the remaining 1572 scans, (2010 = 537, 2011=544, 2012= 558), 74% were valid on above criteria (2010=72%, 2011=75%, 2012=74%). Overall doctors performed more scans than nurses, n = 856 versus n = 713, but nurses had a slightly higher mean success rate, 75.5% vs. 72.5%. Scans were performed by 14 different operators (registrars, consultants and nurses). Individual operator success rates varied widely from 43% to 87%; as did the number of scans performed, median = 70, range 15–373. Success rates were highest in those with formal training, with a weak correlation to number of scans performed (r2= 0.34, p=ns). The commonest scan indications included regional hospital referral (31%), non-alcohol related fatty liver disease (25%), viral hepatitis (13.5%) and alcohol related liver disease (11%).
Conclusion Each year an increasing number of scans are performed, with good overall success rates; although a proportion of scans completed will meet ‘invalid’ criteria and this must be taken into account when interrupting the predicted fibrosis score. Inter-operator variability is evident and relates to prior formal training (undertaken by EchoSens) and total number of scans performed. Nurses undertake scans in dedicated clinics with a set time allowance and this may explain their higher success rates. Transient elastography should, therefore, be performed by those with formal training, undertaking regular scans in a dedicated clinic, to increase validity of results.
Disclosure of Interest None Declared.
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