Management
Diagnosis
➤ In patients with chronic hepatitis C, AGA recommends VCTE, if available,
rather than other nonproprietary, noninvasive serum tests (APRI, FIB-4) to
detect cirrhosis. (Strong recommendation, moderate quality evidence)
➤ In patients with chronic hepatitis C, AGA suggests a VCTE cutoff of
12.5 kPa to detect cirrhosis. (Conditional recommendation, low-quality
evidence)
➤ In noncirrhotic patients with HCV who have achieved a sustained viral
response (SVR) after antiviral therapy, AGA suggests a post-treatment
VCTE cutoff of 9.5 kPa to rule out advanced liver fibrosis. (Conditional
recommendation, very-low quality evidence)
Comment: Noncirrhotic patients with VCTE <9.5 kPa who place a low value on the
inconvenience and risks of continued laboratory and fibrosis testing, and a high value on
avoiding the small risk of developing HCC, may reasonably select to continue specialty care
rather than being discharged from the specialty clinic.
➤ In patients with chronic hepatitis B, AGA suggests VCTE rather than other
nonproprietary noninvasive serum tests (ie, APRI and FIB-4) to detect
cirrhosis. (Conditional recommendation, low-quality evidence)
➤ In patients with chronic hepatitis B, AGA suggests a VCTE cutoff of
11.0 kPa to detect cirrhosis. (Conditional recommendation, low-quality
evidence)
➤ AGA makes no recommendation regarding the role of VCTE in the diagnosis
of cirrhosis in adults with NAFLD. (No recommendation—knowledge gap)
➤ In patients with chronic alcoholic liver disease, AGA suggests a VCTE cutoff
of 12.5 kPa to detect cirrhosis. (Conditional recommendation, low-quality
evidence)
➤ In patients with suspected compensated cirrhosis, AGA suggests a VCTE
cutoff of 19.5 kPa to assess the need for esophagogastroduodenoscopy to
identify high risk esophageal varices. (Conditional recommendation, low-
quality evidence)
Comment: Patients, particularly those at higher risk, with VCTE <19.5 kPa who place a low
value on the inconvenience and risks of endoscopy, and a high value on avoiding the small risk
of acute variceal hemorrhage associated with VCTE values of <19.5 kPa, may reasonably select
to undergo screening endoscopy.
