Utilization of the Fibroscan in Community-Based Clinics
Hefner, Anna Marie
Hassanein, Tarek I.
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Session presented on Saturday, July 23, 2016 and Sunday, July 24, 2016: Purpose: The purpose of the presentation is to disseminate knowledge of the benefits of the Fibroscan technology for patient care decisions in patients with liver disease. Identification of staging of fibrosis impacts the care of the patient with liver disease. The Fibroscan technology measures the stiffness (fibrosis) based on the velocity of transmission of a shear wave through the liver, created by a vibratory source. Currently, this technique has been used most consistently in patients with chronic HCV. Though the liver biopsy has been the 'gold' standard to stage liver fibrosis, it remains an invasive test with sampling error. With the recent advances in hepatitis C therapy and the increased awareness of fatty liver disease, more patients are currently screened for the presence of chronic liver disease. In order to facilitate treatment decisions with patients based on disease severity, the Fibroscan technology has been utilized. The Food and Drug Administration (FDA) recently approved this technology, however, it has been used for many years in Europe to evaluate liver fibrosis. In order to determine the effectiveness and feasibility of this new technology a Fibroscan machine was purchased by a community clinic treating individuals with liver disease in Southern California. The etiology of liver disease was 84.7% hepatitis C, 9.2% fatty liver, 2.4% HBV, 0.1% Alcoholic liver disease, and 3.6% others. Methods: The Southern California Liver Centers developed a Fibrosis Program in order to determine underlying disease severity in patients diagnosed with liver disease. Patients were referred by primary care providers to the Program for a fibroscan if diagnosed with chronic liver disease. SCLC Personnel were trained and certified in the technique of fibroscan through ECHOscan. Between May 2013 and October 2015, 1088 patients were referred to the Fibrosis Program for assessment. Results: A total of 1341 fibroscans were performed from May 2013 to present. Demographics of the patients include: male 795 (57%) and female 576 (43%). The etiology of liver disease was 84.7% hepatitis C, 9.2% fatty liver, 2.4% HBV, 0.1% Alcoholic liver disease, and 3.6% others. The majority of patients referred for fibroscans were patients with hepatitis C (HCV) (n=1088, 84.7%) and were related to evaluation for potential HCV treatment. There were 654 males (60.1%) and 434 females (39.9%). The insurance companies are the driving force for the use of fibroscan for staging of fibrosis for treatment in HCV. Of the patients with a diagnosis of HCV, 80% were born between the year 1945-1965, or babyboomers. Advanced fibrosis/cirrhosis was found in 50.8% of the HCV patients, indicating the need for continued follow up of their liver disease upon completion and cure of HCV. For those individuals with a diagnosis of fatty liver disease, a total of 117 fibroscans were completed. There was 42 males (40%) and 75 females (60%). Advanced fibrosis/cirrhosis was found in 38.5% of the patients with fatty liver disease. However, a liver biopsy was still required for the diagnosis of non-alcoholic steatohepatitis (NASH). Comparative fibroscan and liver biopsy results are being analyzed. Conclusion: The use of elastography performed by Fibroscan, in the community setting allows for rapid, readily available sensitive tool to assess the severity of fibrosis in patients with chronic liver disease and a decrease need for a liver biopsy. The data underscores the importance of staging patients irrespective of age groups and disease entity. Patients and providers were eager to utilize the new technology for disease severity evaluation. Fibroscan will separate patients with no to minimal fibrosis from those with advanced fibrosis and cirrhosis. The clinician has instantaneous results to assist in making decisions during the patient's visit. Given a choice, the patients prefer fibroscan over liver biopsy. As additional studies are conducted, the establishment of this technique will continue to evaluate hepatic fibrosis in patients with chronic liver disease.