title: The role of transient elastography in the detection of liver disease in patients with chronic pancreatitis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Our study provides for the first time evidence that liver stiffness in patients with chronic pancreatitis and concomitant cholestasis can be measured by TE.
authors.affiliation: Service de Gastroentérologie et Hépatologie, Hôpital cantonal Universitaire de Genève, Genève, Switzerland. jean-louis.frossard@hcuge.ch
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Frossard
authors.forename: Emiliano
authors.initials: E
authors.lastname: Giostra
authors.forename: Laura
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.forename: Antoine
authors.initials: A
authors.lastname: Hadengue
authors.forename: Laurent
authors.initials: L
authors.lastname: Spahr
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D050500:Pancreatitis, Chronic / Q000150:complications*; D010976:Platelet Count; D012372:ROC Curve
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: alcoholic cirrhosis; chronic pancreatitis; secondary biliary cirrhosis; transient elastography