title: Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update.
abstract: Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Despite the fact that liver biopsy (LB) has been considered the "gold standard" of assessment of hepatic fibrosis, LB is not favored by patients or physicians owing to its invasiveness, limitations, sampling errors, etc. Therefore, many alternative approaches to assess liver fibrosis are gaining more popularity and have assumed great importance, and many data on such approaches are being generated. The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on liver fibrosis in 2007, with a mandate to develop consensus guidelines on various aspects of liver fibrosis relevant to disease patterns and clinical practice in the Asia-Pacific region. The first consensus guidelines of the APASL recommendations on hepatic fibrosis were published in 2009. Due to advances in the field, we present herein the APASL 2016 updated version on invasive and non-invasive assessment of hepatic fibrosis. The process for the development of these consensus guidelines involved review of all available published literature by a core group of experts who subsequently proposed consensus statements followed by discussion of the contentious issues and unanimous approval of the consensus statements. The Oxford System of the evidence-based approach was adopted for developing the consensus statements using the level of evidence from one (highest) to five (lowest) and grade of recommendation from A (strongest) to D (weakest). The topics covered in the guidelines include invasive methods (LB and hepatic venous pressure gradient measurements), blood tests, conventional radiological methods, elastography techniques and cost-effectiveness of hepatic fibrosis assessment methods, in addition to fibrosis assessment in special and rare situations.
authors.affiliation: Internal Medicine Department, El-Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. g_shiha@hotmail.com.|Egyptian Liver Research Institute And Hospital (ELRIAH), Mansoura, Egypt. g_shiha@hotmail.com.
authors.forename: Gamal
authors.initials: G
authors.lastname: Shiha
authors.affiliation: Department of Internal medicine, University of Benha, Benha, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Ibrahim
authors.affiliation: Department of Tropical Medicine & Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Helmy
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
authors.affiliation: Department of Gastroenterology, University of Tokyo, Tokyo, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.affiliation: Department of Gastroenterology & Hepatology, Ganga Ram Institute for Postgraduate Medical Education & Research of Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Division of Hepatology, North Shore University Hospital and Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bernstien
authors.affiliation: Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Chiba Prefecture, Japan.
authors.forename: Hitushi
authors.initials: H
authors.lastname: Maruyama
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Saraswat
authors.affiliation: Post Graduate Institute of Medial Education & Research, Chandigarh, India.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Chawla
authors.affiliation: Department of Medicine, The Aga Khan University & Hospital, Stadium Road, Karachi, Pakistan.
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
authors.affiliation: Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.affiliation: Department of Pathology, Physiology and Imaging, University Paris Diderot, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bedossa
authors.affiliation: Govind Ballabh Pant Hospital, Maulana Azad Medical College, New Delhi, India.
authors.forename: Puja
authors.initials: P
authors.lastname: Sakhuja
authors.affiliation: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.forename: Mamun
authors.initials: M
authors.lastname: Elmahatab
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Seng Gee
authors.initials: SG
authors.lastname: Lim
authors.affiliation: Department of Medicine, University of Indonesia, Depok, Indonesia.
authors.forename: Laurentius
authors.initials: L
authors.lastname: Lesmana
authors.affiliation: University of Santo Tomas, España Blvd, Manila, Philippines.
authors.forename: Jose
authors.initials: J
authors.lastname: Sollano
authors.affiliation: Liver Research Centre at the Beijing Friendship Hospital, Capital University in Beijing, Beijing, China.
authors.forename: Ji-Dong
authors.initials: JD
authors.lastname: Jia
authors.affiliation: Department of Internal Medicine, Military Medical Academy, Cairo, Egypt.
authors.forename: Bahaa
authors.initials: B
authors.lastname: Abbas
authors.affiliation: Tropical Medicine Department, Cairo Medical School, Cairo, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Omar
authors.affiliation: Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
authors.forename: Barjesh
authors.initials: B
authors.lastname: Sharma
authors.affiliation: Section of Gastroenterology, Cardinal Santos Medical Center, San Juan City, Metro Manila, Philippines.
authors.forename: Diana
authors.initials: D
authors.lastname: Payawal
authors.affiliation: Pediatric Hospital, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdallah
authors.affiliation: College of Medicine, Taif University, Taif, Kingdom of Saudi Arabia.
authors.forename: Abdelhamid
authors.initials: A
authors.lastname: Serwah
authors.affiliation: Hepatology and Diabetes Unit, Military Medical Academy, Cairo, Egypt.
authors.forename: Abdelkhalek
authors.initials: A
authors.lastname: Hamed
authors.affiliation: Hepatology & GIT Department, AHF Center Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors.forename: Aly
authors.initials: A
authors.lastname: Elsayed
authors.affiliation: Internal Medicine Department, Faculty of Medicine Cairo University, Liver Transplant Unit Manial Hospital and Liver ICU French Hospital, Cairo University, Cairo, Egypt.
authors.forename: Amany
authors.initials: A
authors.lastname: AbdelMaqsod
authors.affiliation: Chula Vista Medical Center, Chula Vista, CA, USA.
authors.forename: Tarek
authors.initials: T
authors.lastname: Hassanein
authors.affiliation: Molecular Pathology Unit & Research Group, German University in Cairo, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ihab
authors.affiliation: Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia.
authors.forename: Hamsik
authors.initials: H
authors.lastname: GHaziuan
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, USA.
authors.forename: Nizar
authors.initials: N
authors.lastname: Zein
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.
authors.forename: Manoj
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authors.lastname: Kumar
mesh_terms: D001706:Biopsy; D032921:Consensus; D003362:Cost-Benefit Analysis; D054459:Elasticity Imaging Techniques / Q000191:economics / Q000379:methods; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis*; D015588:Observer Variation
keywords: Chronic liver disease; Cirrhosis; Graft fibrosis; Hepatitis B; Hepatitis C; Invasive assessment, non-invasive assessment; Liver fibrosis; Non-alcoholic steatohepatitis