Diagnosis
➤ In patients with suspected chronic liver disease undergoing elective
nonhepatic surgery, AGA suggests a VCTE cutoff of 17.0 kPa to detect
clinically significant portal hypertension to inform preoperative care.
(Conditional recommendation, low-quality evidence)
Comment: Patients, particularly those at higher risk, with VCTE <17.0 kPa who place a
low value on the inconvenience and risks of interventions (endoscopy, hepatic venous pressure
gradient measurement) to detect clinically significant portal hypertension, and a high value
on avoiding the small risk of operative morbidity and mortality associated with elective
nonhepatic surgery, may reasonably select to undergo screening endoscopy.
➤ In adult patients with chronic hepatitis C, AGA suggests using VCTE
rather than magnetic resonance elastography (MRE) for detection of
cirrhosis. (Conditional recommendation, very low-quality evidence)
➤ In adults with NAFLD and a higher risk of cirrhosis, AGA suggests
using MRE, rather than VCTE, for detection of cirrhosis. (Conditional
recommendation, low-quality evidence)
• In adults with NAFLD and a lower risk of cirrhosis, AGA makes no recommendation
regarding the role of MRE or VCTE for detection of cirrhosis.
(No recommendation—knowledge gap)
Comment: High-risk populations are NAFLD with advanced age, obesity, particularly
central adiposity, diabetes, alanine elevated >2× upper limit of normal with an estimated
cirrhosis prevalence of 30% (typically seen in a referral setting ). Low-risk population are
those with NAFLD and signs of fatty liver on imaging only and an estimated cirrhosis
prevalence of ≤5% (typically seen in a primary care setting ).
