Review
Copyright ©The Author(s) 2016.
World J Gastrointest Pharmacol Ther. Feb 6, 2016; 7(1): 91-106
Published online Feb 6, 2016. doi: 10.4292/wjgpt.v7.i1.91
Table 2 What the clinician needs to know about transient elastography (Fibroscan®)
1 Clinical indications for TE
Liver diseaseIndications for TEPotential clinical applications
Chronic liver diseaseTo assess for severity of fibrosisAssist in treatment decisions in CHC and CHB
Selection of patients for treatment trials
Decision to continue or stop MTX
To diagnose early cirrhosisCommence variceal screening and HCC surveillance, monitor for decompensation
Longitudinal assessment of fibrosisAssess for progression of fibrosis in untreated patients and for regression of fibrosis/cirrhosis in treated patients
Patients with NAFLDAssess severity of fibrosis and steatosis (with Fibroscan-CAP)Aggressive control of risk factors
Selection of patients for treatment trials
Selection of patients for liver biopsy
Post-liver transplantAssess for fibrosis in recurrent CHC post liver transplantAvoid protocol liver biopsies for diagnosis of fibrosis
Non-cirrhotic portal hypertensionExclude cirrhosisAssists in differentiating cirrhotic vs non-cirrhotic portal hypertension
Patients with cirrhosisPredict significant portal hypertension and risk of liver-related eventsStratify frequency of follow-up in low-risk vs high-risk cirrhotics
Predict absence of varicesAvoid/delay endoscopy screening in cirrhotics at low risk for varices
2 Conditions that affect accuracy of TE
ConditionHow it affects the TE resultWhat the clinician should do
Post-mealLSMs are elevated after meals due to increased hepatic venous flowPatients should fast for at least 3 h before TE measurement
Elevated ALTLSMs are elevated due to hepatic inflammationRepeat or delay TE till after ALT has returned to baseline/normal levels
Use ALT-based LSM cut-off values to interpret LSM result
Use probability-based LSM interpretation scores which account for ALT
Cardiac failureLSMs are elevated due to hepatic congestion in right heart failureRepeat or delay TE until after patient’s heart failure is treated
CholestasisLSMs are elevated due to increased stiffness from biliary dilatationRepeat or delay TE until after biliary obstruction is resolved
Operator experienceOperator inexperience may lead to higher rate of unsuccessful or invalid LSM resultsTE should be performed by operators with prior experience of at least 50-100 examinations
ObesityHigher rate of unsuccessful LSMs due to increased SCD because of increased subcutaneous fatUse XL probe if SCD > 3.4 cm (with the current Fibroscan 502 Touch®, the machine will automatically advise when the XL probe should be used)
If LSM is unsuccessful with XL probe, use alternative non-invasive test
AscitesHigh rate of unsuccessful LSM due to interruption of shear waves by ascitesUse alternative non-invasive test
Pregnancy, cardiac pacemaker, AICDSafety of TE in these conditions have not been assessedTE contraindicated