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Msg  48851 of 50472  at  12/2/2023 12:50:20 PM  by


 In response to msg 48850 by  sling5
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You know, I think some of  you  Nasher's missed my post  about
the new guidelines in the  the diagnostic space , Nov 10th (sling does 
bring it up in the post I'm tagging on to ) :

The guidance, titled "AASLD Practice Guidance on Risk Stratification and Management of Portal Hypertension and Varices in Cirrhosis," provides a detailed outline for using liver stiffness measurement (LSM) by transient elastography (TE) to stage advanced chronic liver disease (ACLD), identify clinically significant portal hypertension (CSPH), and to determine the stage-specific role of upper endoscopy to identify varices needing treatment (VNT).

"Managing portal hypertension in cirrhotic patients is a daily challenge for healthcare professionals," said Jon Gingrich, CEO of Echosens North America. "Given the high mortality rates associated with these conditions, there's an urgent need for effective treatments and early diagnosis. The latest guidance underscores the promise of noninvasive methods for monitoring advanced liver disease patients."

The recently issued guidance represents a shift in diagnosing and managing advanced liver disease, moving away from invasive procedures such as liver biopsies and Hepatic Venous Pressure Gradient (HVPG) measurements to more noninvasive tests. This alternative approach introduces the concepts of "advanced chronic liver disease" (ACLD) and "compensated advanced chronic liver disease" (cACLD), both of which rely on liver stiffness measurements to noninvasively assess patients that are close to cirrhosis (ACLD) or those with ACLD without prior decompensation (cACLD).

This new guidance encapsulates optimal practices for identifying and managing portal hypertension and varices in chronic liver disease. It identifies FibroScan, in conjunction with platelet count, as the most validated noninvasive staging system for compensated cirrhosis. It also endorses the "Rule of Five," a simple tool used to quantify the escalating relative risk of decompensation and liver-related mortality. This rule also helps define cACLD, CSPH, and the threshold for screening upper endoscopy. The guidance also notes the strong correlation of spleen stiffness measurements (SSM), a measurement exclusive to FibroScan, with HVPG values (>10 mm Hg) and the potential role of SSM in ruling out varices needing treatment.

Dominique Legros, Global CEO of Echosens, added, "The endorsement of non-invasive methods for advanced disease from the AASLD fortifies our commitment to equip healthcare practitioners with accessible tools that are reliable, precise, and user-friendly. We are steadfast in our belief that noninvasive technologies hold the potential to radically transform the landscape of liver disease diagnosis and monitoring, thereby enhancing patient prognosis significantly."

 So, FibroScan . And, if you bother to go to the Echosens website , type
in FibroScan golly they are all over the map. Look at this :
So, it's not going to be impossible to find a location nearby . 
Question is ..... for me anyway ..... is this type of scan acceptable to the
FDA to get approval (seems so) or will they require those ugly biopsies ?  
Okay, I'm cranky . Dealing with some medical issues on the home front so
please excuse my impatience 

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