| Advantages | Direct measure of liver fibrosis Well established staging system Assessment of architectural disturbances related to liver fibrosis Evaluation of associated lesions (inflammation, steatosis, iron, alcohol)
| | Non-invasive Easy to repeat No risk to patient No contraindication Performed in the outpatient clinic Results available immediately Reproducible Liver stiffness is a genuine physical property of liver tissue Highly performant for detecting cirrhosis Prognostic value likely in cirrhosis Combination with serum markers increases diagnostic accuracy
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| Disadvantages | Invasive and painful (10–30%) Difficult to repeat Potential life-threatening complications (0.03%) including mortality (0.01%) Contraindicated in presence of ascites, coagulopathy and thrombocytopaenia Sampling and interobserver variability Understaging of fibrosis in 30% of cases
| Unable to discriminate between intermediate stages of fibrosis Surrogates non specific of the liver Limitations (rheumatoid arthritis, Gilbert syndrome, haemolysis, etc.)
| Unable to discriminate between intermediate stages of fibrosis Applicability lower than serum marker: failure in ∼5% of cases and unreliable results in 15% (obesity, ascites, limited operator experience) False positive in case of acute hepatitis, extrahepatic cholestasis and congestive heart failure
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