EUS-guided liver palpation as a screening tool for advanced fibrosis and cirrhosis in patients with suspected metabolic dysfunction-associated steatotic liver disease: a pilot study.

Background and Aims: Endoscopic liver "palpation" can be performed by indenting the liver surface under EUS. Indentation depth is measured with the use of sonographic calipers. We hypothesized that fibrotic livers are more difficult to indent, and that indentation can accurately predict liver fibrosis staging. We compared EUS-guided liver palpation and conventional screening modalities in patients with suspected metabolic dysfunction-associated steatotic liver disease.
Methods: This was a cross-sectional pilot study. Consecutive patients at 3 hospitals from 2021 to 2023 underwent EUS-guided palpation with liver biopsy. Liver palpation was compared with fibrosis-4 index (FIB-4), aspartate transaminase to platelet ratio index (APRI), nonalcoholic fatty liver disease fibrosis score (NFS), and transient elastography in predicting fibrosis staging on histology. Area under the receiver operating characteristic curve analysis was performed.
Results: Seventy-three patients were included. Mean age was 49.1 years, and 71.2% were female. Mean body mass index was 41.1 kg/m. ² Indentation depth was negatively correlated with fibrosis stage (Kruskal-Willis test, P < .0001). EUS palpation demonstrated c-statistics of 0.79 and 0.95 in discriminating advanced fibrosis and cirrhosis, respectively. EUS liver palpation was superior to NFS in predicting advanced fibrosis (P = .0057) and superior to APRI and NFS in predicting cirrhosis (P = .0099 and P = .045, respectively). EUS palpation was not significantly different from FIB-4. EUS palpation was superior to transient elastography in predicting cirrhosis (P = .045). When optimal cutoffs were used, indentation measurement ≤3.5 mm yielded 100% predictive value for ruling in advanced fibrosis, and ≥4.0 mm yielded 100% predictive value for ruling out cirrhosis.
Conclusions: EUS liver palpation is a novel, accurate, and easy-to-use screening tool for advanced fibrosis and cirrhosis in patients with metabolic dysfunction-associated steatotic liver disease.
Competing Interests: Disclosure The following authors disclosed financial relationships: C. C. Thompson: Consultant, Apollo Endosurgery and Covidien/Medtronic; Venture Fund General Partner, BlueFlame Healthcare; Consultant/Research Support, Boston Scientific; Founder/Consultant/Board Member, Enterasense Ltd; Founder/Consultant/Board Member, EnVision Endoscopy; Research Support, ERBE; Consultant/Advisory Board, Fractyl; Consultant/Research Support, GI Dynamics; Founder/Consultant/Board Member, GI Windows; Consultant/Research Support, Olympus/Spiration; Consultant/Advisory Board Member/Research Support, USGI Medical; Consultant/Research Support, Fujifilm, Consultant/Research Support, Lumendi; Consultant, Xenter; Consultant/Research Support, Endoquest Robotics. K. Chang: Consultant for Olympus and Fujifilm. M. Ryou: Consultant for Olympus, Fujifilm, Cook, Boston Scientific, GI Windows Surgical, and EnteraSense. P. Jirapinyo: Consultant/Advisory Board Member/Research Support, Apollo Endosurgery; Consultant/Research Support, Boston Scientific; Consultant, ERBE; Consultant/Advisory board Member/Research Support, Fractyl; Research Support, GI Dynamics; Consultant, Spatz Medical; Research Support, USGI Medical. The other authors disclosed no financial relationships.
(Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)