title: Transient Elastography (FibroScan) Is Not Correlated With Liver Fibrosis but With Cholestasis in Patients With Long-Term Home Parenteral Nutrition.
abstract: BACKGROUND
  Long-term home parenteral nutrition (HPN) may induce liver disorders. Transient elastography (TE) has been proposed as a noninvasive alternative to liver biopsy analysis for assessment of the progression of hepatic fibrosis to cirrhosis. The goal of this study was to compare values from TE measurements to biopsy-determined stages of histologic fibrosis in patients receiving HPN.
  
  
  METHODS
  In this multicenter prospective study, patients receiving long-term HPN (≥ 6 months) who required a liver biopsy for clinical reasons were included. TE (FibroScan) values for each patient were compared with the degree of hepatic fibrosis measured from biopsy specimens based on the Brunt classification. TE values were also correlated to biochemical and histologic cholestasis. Two noninvasive indices for predicting liver fibrosis (APRI and FIB-4) were also evaluated.
  
  
  RESULTS
  Thirty patients were included in this study (mean age, 42.1 years; 63% male). The mean duration of HPN was 100.7 months; 25 patients had a short bowel and 13 had an intestinal stoma. Biochemical cholestasis was described in 22 patients. Liver histologic features varied among these patients. There was no correlation between the values of TE and the stages of histologic fibrosis, but TE values were significantly correlated to serum bilirubin level and the severity of histologic cholestasis as well as APRI and FIB-4 scores.
  
  
  CONCLUSIONS
  In patients with long-term HPN, TE failed to assess the degree of hepatic fibrosis. This could be due to the heterogeneity of liver histologic features observed in these patients and the presence of chronic cholestasis.
authors.affiliation: Department of Gastroenterology and Pathology, Hôpital Erasme, Brussels, Belgium andre.vangossum@erasme.ulb.ac.be.
authors.forename: André
authors.initials: A
authors.lastname: Van Gossum
authors.affiliation: Department of Gastroenterology and Pathology, St Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Loris
authors.initials: L
authors.lastname: Pironi
authors.affiliation: Department of Gastroenterology and Pathology, Hôpital Beaujon, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Messing
authors.affiliation: Department of Gastroenterology and Pathology, Hôpital Erasme, Brussels, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Moreno
authors.affiliation: Department of Gastroenterology and Pathology, St Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.affiliation: Department of Gastroenterology and Pathology, St Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: D'Errico
authors.affiliation: Department of Gastroenterology and Pathology, Hôpital Erasme, Brussels, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Demetter
authors.affiliation: Department of Gastroenterology and Pathology, Hôpital Beaujon, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: De Gos
authors.affiliation: Department of Gastroenterology and Pathology, Hôpital Beaujon, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Cazals-Halem
authors.affiliation: Department of Gastroenterology and Pathology, Hôpital Beaujon, Paris, France.
authors.forename: Francisca
authors.initials: F
authors.lastname: Joly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D015992:Body Mass Index; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D006400:Hematocrit; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000378:metabolism
chemical_list: D012709:Serum Albumin; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase; D001663:Bilirubin
keywords: cholestasis; fibrosis; home parenteral nutrition; intestinal failure; liver; transient elastography