Ruling out esophageal varices in NAFLD cirrhosis: Can we do without endoscopy?

Franchis, Roberto de; Krag, Aleksander

doi:10.1016/j.jhep.2018.06.013

Cited by 8 publications

(1 citation statement)

References 17 publications

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“…Furthermore, patients with advanced fibrosis (F3-F4) had more tests and studies done and more referrals placed. This not only represents appropriate allocation and utilization of care, but also may serve to quell providers’ worries that identification of NAFLD patients may lead to unnecessary testing, in particular endoscopies for variceal surveillance[ 24 ].…”

Section: Discussionmentioning

confidence: 99%

To scan or not to scan: Use of transient elastography in an integrated health system

Stein¹,

Mittal²,

Song³

et al. 2023

World J Hepatol

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BACKGROUND Non-invasive tests, such as Fibrosis-4 index and transient elastography (commonly FibroScan), are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease (NAFLD). In 2018, a clinical decision support tool (CDST) was implemented to guide primary care providers (PCPs) on use of FibroScan for NAFLD. AIM To analyze how this CDST impacted health care utilization and patient outcomes. METHODS We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017 (pre-CDST) or January 2018 to December 2020 (post-CDST). Outcomes included FibroScan result, laboratory tests, imaging studies, specialty referral, patient morbidity and mortality. RESULTS We identified 958 patients who had FibroScan, 115 before and 843 after the CDST was implemented. The percentage of FibroScans ordered by PCPs increased from 33% to 67.1%. The percentage of patients diagnosed with early F1 fibrosis, on a scale from F0 to F4, increased from 7.8% to 14.2%. Those diagnosed with advanced F4 fibrosis decreased from 28.7% to 16.5%. There were fewer laboratory tests, imaging studies and biopsy after the CDST was implemented. Though there were more specialty referrals placed after the CDST was implemented, multivariate analysis revealed that healthcare utilization aligned with fibrosis score, whereby patients with more advanced disease had more referrals. Very few patients were hospitalized or died. CONCLUSION This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.

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Section: Discussionmentioning

confidence: 99%