Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Feb 6, 2016; 7(1): 91-106
Published online Feb 6, 2016. doi: 10.4292/wjgpt.v7.i1.91
Clinical applications, limitations and future role of transient elastography in the management of liver disease
Pik Eu Chang, George Boon-Bee Goh, Jing Hieng Ngu, Hiang Keat Tan, Chee Kiat Tan
Pik Eu Chang, George Boon-Bee Goh, Jing Hieng Ngu, Hiang Keat Tan, Chee Kiat Tan, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169586, Singapore
Pik Eu Chang, Chee Kiat Tan, George Boon-Bee Goh, Duke-NUS Graduate Medical School, Singapore 169587, Singapore
Author contributions: Chang PE designed the framework of the review, performed the final edits and revision of the manuscript; Chang PE, Goh GBB, Ngu JH, Tan HK and Tan CK contributed towards drafting the article and final approval of the manuscript.
Conflict-of-interest statement: None of the authors have any conflict of interests related to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Pik Eu Chang, Jason, Department of Gastroenterology and Hepatology, Singapore General Hospital, 20 College Road, Level 3, Academia Building, Singapore 169856, Singapore. jason.chang@sgh.com.sg
Telephone: +65-63214684 Fax: +65-62273623
Received: July 2, 2015
Peer-review started: July 9, 2015
First decision: August 25, 2015
Revised: September 22, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: February 6, 2016
Processing time: 210 Days and 19.3 Hours
Abstract

Transient elastography (TE) is a reliable tool for the non-invasive assessment of liver fibrosis in routine clinical practice. TE is currently approved for use in Europe, Asia and the United States. The widespread adoption of this technology is certain to increase the use of TE worldwide. Although TE has been well validated in chronic viral hepatitis, its clinical role in other liver diseases remains less clear. The advent of new treatment for chronic hepatitis C and emerging prevalence of non-alcoholic steatohepatitis raises new questions on the role of TE in current clinical practice. This review aims to examine the clinical applications, limitations and future role of TE in current clinical practice in light of the changing epidemiology of liver diseases and new clinical management paradigms. In current clinical practice, TE is the most accurate non-invasive method for diagnosis of liver cirrhosis. TE is useful to rule out fibrosis and cirrhosis but does not have sufficient accuracy to discern between various stages of fibrosis. The clinical role of TE has evolved from cross-sectional point-in-time assessment of fibrosis and cirrhosis to the more relevant role of prediction of vital clinical end-points. This provides clinicians with the ability to modify treatment strategies based on the information provided by TE. TE has evolved over the past decade to become an essential tool to assist the clinician in the management of chronic liver disease.

Keywords: Liver stiffness; Transient elastography; Non-invasive; Fibrosis; Chronic

Core tip: Transient elastography (TE) is a reliable tool for the non-invasive assessment of liver fibrosis in routine clinical practice. Although TE has been well validated in chronic viral hepatitis, its clinical role in other liver diseases remains less clear. The advent of new treatment for chronic hepatitis C and emerging prevalence of non-alcoholic steatohepatitis raises new questions on the role of TE in current clinical practice. This review aims to examine the clinical applications, limitations and future role of TE in current clinical practice in light of the changing epidemiology of liver diseases and new clinical management paradigms.