EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version)

2017 BMC Gastroenterology 15;1 (183)

FIBROSIS STAGING IN CHRONIC HEPATITIS C
Recommendation 15: TE can be used as the first-line assessment for the severity of liver fibrosis in patients with chronic viral hepatitis C. It performs best with regard to the ruling out of cirrhosis (LoE 1b, GoR A) [4] [98] [100]. Broad consensus (17/0/1, 94 %) RECOMMENDATION 19 LSM changes after successful anti-HCV treatment should not affect the management strategy (e. g. surveillance for HCC occurrence in patients at risk) (LoE 3, GOR D) [52]. Broad con- sensus (16/0/1, 94% FIBROSIS STAGING IN CHRONIC HEPATITIS B Recommendation 20 TE is useful in patients with CHB to identify those with cirrhosis. Concomitant assessment of transaminases is required to exclude flare up (elevation > 5 times upper limit of normal). (LoE 1b, GoR A) [128] [129] [130]. Broad consensus (17/1/0, 94 %) Recommendation 21 TE is useful in inactive HBV carriers to rule out fibrosis (LoE 2, GOR B) [138] [139]. Strong consensus (18/0/0, 100 %) Recommendation 24 LSM changes under HBV treatment should not affect the management strategy (e. g. surveillance for HCC occurrence in patients at risk) (LoE 2b, GOR B) [148] [149]. Strong consensus (16/0/0, 100 %) FIBROSIS STAGING IN NAFLD Recommendation 25 TE can be used to exclude cirrhosis in NAFLD patients (LoE 2a, GoR B) [52] [160]. Broad consensus (13/0/3, 81 %) FIBROSIS STAGING IN ALD TE can be used to exclude cirrhosis in patients with alcoholic liver disease, provided that acute alcoholic hepatitis is not present (LoE 2b, GoR B) [30] [164] [169] [170]. Strong consensus (15/0/0, 100 %) PORTAL HYPERTENSION Recommendation 27 LSM with TE is useful to identify patients with a high likelihood of having clinically significant portal hypertension (HVPG ≥ 10 mmHg) (LoE 2b, GoR B) [188] [189]. Strong consensus (15/0/0, 100 %) Recommendation 28 Liver stiffness using TE combined with platelet count is useful to rule out varices requiring treatment (LoE 2b, GoR B) [194]. Although preliminary results are encouraging, there is insufficient evidence to recommend pSWE and 2D-SWE in this setting. Broad consensus (13/0/1, 93 %)

Pubmed : 28407654