Screening for Liver Fibrosis in General or At-Risk Populations Using Transient Elastography

Liver cirrhosis is a major cause of death worldwide and accounts for a large number of hospitalizations. Deaths due to cirrhosis increased by 46% between 1990 and 2013, and it has become the fifth leading cause of death worldwide. So far, no reliable and noninvasive test has been available to perform population-wide screening for cirrhosis. However, the recent introduction of transient elastography (TE) which measures liver stiffness (LS) has allowed for the first time to noninvasively screen larger cohorts for the presence of liver cirrhosis. This chapter provides an overview of the first screening studies based on TE either in the general population or in population at specific risk to develop liver disease. In summary, population-wide screening studies show a prevalence of elevated LS between 5.6 and 7.5% while an elevated LS was found between 18 and 27% among individuals with risk factors. These findings indicate an alarmingly high prevalence of chronic liver diseases in the general population, mainly related to NAFLD and ALD. However, whether a global screening strategy with noninvasive methods such as TE is cost-effective in terms of health outcomes and treatment costs is still a matter of debate. Taken together, screening programs for liver fibrosis with TE in both the general population and in patients with risk factors for chronic liver diseases such as diabetes may be cost-effective and could be implemented across countries and different healthcare systems in Europe.