The role of transient elastography in the detection of liver disease in patients with chronic pancreatitis.

BACKGROUND & AIMS: Quantification of liver stiffness with transient elastography (TE) is validated for staging hepatic fibrosis in chronic hepatitis C infection. The current study was aimed to assess the diagnostic performance of liver stiffness measurement for the determination of fibrosis stage in patients with chronic pancreatitis. METHODS: Thirty consecutive patients with chronic pancreatitis and increased liver enzyme were enrolled over a 2.5-year period. Eight liver living donor candidates were recruited to serve as internal controls. The TE values were compared with non-invasive fibrosis scoring systems including aspartate transaminase (AST)/alanine aminotransferase (ALT) ratio, APRI, non-alcoholic fatty liver disease NAFLD score, FIB-4 index and to liver histology. RESULTS: TE was successful in all patients. Stiffness values ranged from 3.1 to 69 kPa (mean 16.9). Liver stiffness was correlated with fibrosis stage (Spearman's correlation 0.73, P < 0.0001). Areas under receiver operator characteristics curves for fibrosis F = 4 were 0.92 for TE, 0.87 for FIB-4 index, 0.81 for APRI, 0.73 for NAFLD score and 0.71 for AST/ALT ratio. Optimal stiffness cut-off values for diagnosis fibrosis F = 4 was 10.9 kPa, with 90% sensitivity, 85% specificity and 86% accuracy. CONCLUSION: Our study provides for the first time evidence that liver stiffness in patients with chronic pancreatitis and concomitant cholestasis can be measured by TE.