Non Invasive Screening for Liver Cirrhosis in Addicted Patients Organizer/Chair: Sebastian MUELLER / Co-Chair: Laurent SANDRIN S183 IS LIVER STIFFNESS THE NOVEL GOLD STANDARD PARAMETER TO DIAGNOSE ALCOHOLIC LIVER CIRRHOSIS?

Noninvasive screening for liver cirrhosis in patients addicted to drugs or alcohol has been a continuing problem in internal and addictive medicine. This has dramatically changed with the recent introduction of transient elastography (Fibroscan) to directly measure liver stiffness (LS). This novel technique is expanding rapidly around the globe since it allows the diagnosis of liver cirrhosis in a true bed-side manner within minutes. LS is an excellent screening parameter for cirrhosis with a high negative predictive value. Thus, a normal LS < 6 kPa excludes ongoing liver disease while a LS of 8 kPa and 12.5 kPa represent generally accepted cut-off values for F3 and F4 fibrosis. Meanwhile, LS has also been successfully used to monitor treatment outcome of patients with alcoholic liver cirrhosis and as prognostic parameter for hepatic complications such as the risk of variceal bleeding or hepatocellular carcinoma. However, it is important to conceive that several other factors apart from cirrhosis stage may affect LS. Such factors include liver inflammation, liver congestion, cholestasis and rare conditions such as amyloidosis or mastocytosis. Thus, although LS is an excellent screening tool for liver disease, it should always be interpreted in the clinical context. For such a hepatological expert interpretation of LS values, a concomitant ultrasound and laboratory parameters are required which will increase the diagnostic accuracy over 99%. Novel actual algorithms will be discussed especially with regard to alcoholic liver disease, how to interpret increased LS values within the clinical setting.