• Jeremy Chak-Lun Chow, Grace Lai-Hung Wong, Anthony Wing-Hung Chan, Sally She-Ting Shu, Carmen Ka-Man Chan, Julie Ka-Yu Leung, Paul Cheung-Lung Choi, Angel Mei-Ling Chim, Henry Lik-Yuen Chan, and Vincent Wai-Sun Wong.
• Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
• J. Gastroenterol. Hepatol. 2019 Jan 1; 34 (1): 241-248.

Background And AimThe Baveno VI Consensus recommends repeating examination in patients with high liver stiffness measurement (LSM) by transient elastography to reduce false-positive diagnosis of advanced liver disease. We tested whether repeating transient elastography can increase the overall diagnostic accuracy.MethodsNinety-seven patients with non-alcoholic fatty liver disease who underwent two FibroScan examinations within 6 months prior to liver biopsy were evaluated. An LSM cut-off of 7.9 kPa was used to exclude F3-4 fibrosis.ResultsSeventy-eight patients had high LSM at baseline, among whom 27 had low LSM on repeated testing; only four had F3 and none had cirrhosis. In contrast, 31 of 51 patients with high LSM at both examinations had F3-4. Nineteen patients had low LSM at baseline; none of them had F3-4 regardless of the second LSM results. If we took LSM <7.9 kPa at either examination as sufficient to exclude F3-4, the negative predictive value remained high at 91%. The positive predictive value for F3-4 increased from 45% in patients with high LSM at baseline to 61% in those with high LSM at both examinations. Sensitivity analysis using different cut-offs yielded similar results, with 76% of patients with LSM >12 kPa at both examinations having F3-4.ConclusionsTransient elastography is a highly sensitive screening test to exclude F3-4 fibrosis in non-alcoholic fatty liver disease patients. One-third of patients with high LSM may have normal results on repeated examination. By repeating examination in cases with high LSM, one may spare patients from unnecessary liver biopsy.© 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

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