Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7236
Peer-review started: April 26, 2016
First decision: May 30, 2016
Revised: June 28, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: August 28, 2016
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Currently, the routinely used modalities are unable to adequately determine the levels of steatosis and fibrosis (laboratory tests and ultrasonography) or cannot be applied as a screening procedure (liver biopsy). Among the non-invasive tests, transient elastography (FibroScan®, TE) with controlled attenuation parameter (CAP) has demonstrated good accuracy in quantifying the levels of liver steatosis and fibrosis in patients with NAFLD, the factors associated with the diagnosis and NAFLD progression. The method is fast, reliable and reproducible, with good intra- and interobserver levels of agreement, thus allowing for population-wide screening and disease follow-up. The initial inability of the procedure to accurately determine fibrosis and steatosis in obese patients has been addressed with the development of the obese-specific XL probe. TE with CAP is a viable alternative to ultrasonography, both as an initial assessment and during follow-up of patients with NAFLD. Its ability to exclude patients with advanced fibrosis may be used to identify low-risk NAFLD patients in whom liver biopsy is not needed, therefore reducing the risk of complications and the financial costs.
Core tip: Non-alcoholic fatty liver disease (NAFLD) patients are at risk of NAFLD-related cirrhosis and hepatocellular carcinoma, particularly in the setting of liver fibrosis with concurrent metabolic syndrome. Transient elastography (TE) with controlled attenuation parameter (CAP) is a fast, reliable, repeatable non-invasive method for the assessment of liver steatosis and fibrosis. TE with CAP may be used to diagnose and monitor patients with NAFLD. TE with CAP is a favorable means of excluding advanced fibrosis.