Guidelines for the use of transient elastography in South Africa

ABSTRACT

Liver fibrosis assessment is key to rapid decision making with respect to treatment and prognosis in liverdisease Liver biopsy remains the gold standard for assessing fibrosis and pattern of injury but is invasive, costly, relatively unavailable and is unsuited to the rapid and efficient upscaling of treatment to those in need of care e.g. viral hepatitis Non invasive technologies are supplanting liver biopsy as the primary means of assessing liver fibrosis Transient elastography (FibroScan® ) ­ first introduced in 2003 ­ has evolved as a reliable and validated noninvasive technology for assessing liver fibrosis The technique is simple and requires easily transferrable operator skills A minimum of 10 readings are required to be valid Substantial data supports its validity in a variety of chronic liver diseases with AUROC scores that range between 0.85 and 0.95 FibroScan® has the added benefit of assessing fatty change in the liver via the CAP (Controlled Attenuation Parameter) assessment score Potential users of this technology should acquire the requisite upskilling to operate Transient Elastography (FibroScan® ) To achieve the objectives of the National Viral Hepatitis Elimination Strategy in South Africa, such technology will be needed in the public sector The cost effectiveness of this technology with appropriate allocation of funding codes is required for the private sector