1.0.0.0 Rec­om­men­da­tions and GRADE

1.1.0.0 Rec­om­men­da­tions

Sr.­­no.

Rec­om­men­da­tions

SoR

QoE

1

In pa­tients with chron­ic hep­ati­tis C, the AGA rec­om­mends VCTE, if avail­able, rather than other non­pro­pri­etary, non­in­va­sive serum tests (APRI, FIB-4) to de­tect cir­rhosis.

Strong

Mod

Ev­i­dence for rec­om­men­da­tion 1

2

In pa­tients with chron­ic hep­ati­tis C, the AGA sug­gests a VCTE cut­off of 12.5 kPa to de­tect cir­rhosis.

Cond

Low

Ev­i­dence for rec­om­men­da­tion 2

3

In non­cir­rhot­ic pa­tients with HCV who have achieved SVR after an­tivi­ral ther­a­py, the AGA sug­gests a post-‍treat­ment vi­bra­tion con­trolled tran­sient elas­tog­ra­phy cut­off of 9.5 kPa to rule out ad­vanced liver fi­bro­sis.
Com­ment: Non­cir­rhot­ic pa­tients with VCTE <9.5 kPa who place a low value on the in­con­ve­nience and risks of con­tin­ued lab­o­ra­to­ry and fi­bro­sis test­ing, and a high value on avoid­ing the small risk of de­vel­op­ing HCC, may rea­son­ably se­lect to con­tin­ue spe­cial­ty care rather than being dis­charged from the spe­cial­ty clin­ic.

Cond

V Low

Ev­i­dence for rec­om­men­da­tion 3

4

In pa­tients with chron­ic hep­ati­tis B, the AGA sug­gests VCTE rather than other non­pro­pri­etary non­in­va­sive serum tests (ie, APRI and FIB-4) to de­tect cir­rhosis.

Cond

Low

Ev­i­dence for rec­om­men­da­tion 4

5

In pa­tients with chron­ic hep­ati­tis B, the AGA sug­gests a VCTE cut­off of 11.0 kPa to de­tect cir­rhosis.

Cond

Low

Ev­i­dence for rec­om­men­da­tion 5

6

The AGA makes no rec­om­men­da­tion re­gard­ing the role of VCTE in the di­ag­no­sis of cir­rhosis in adults with NAFLD.

N/A

N/A

Ev­i­dence for rec­om­men­da­tion 6

7

In pa­tients with chron­ic al­co­holic liver dis­ease, the AGA sug­gests a VCTE cut­off of 12.5 kPa to de­tect cir­rhosis.

Cond

Low

Ev­i­dence for rec­om­men­da­tion 7

8

In pa­tients with sus­pect­ed com­pen­sat­ed cir­rhosis, the AGA sug­gests a vi­bra­tion con­trolled tran­sient elas­tog­ra­phy cut­off of 19.5 kPa to as­sess the need for esoph­a­gogas­tro­duo­denoscopy to iden­ti­fy high risk esophageal varices.
Com­ment: Pa­tients, par­tic­u­lar­ly those at high­er risk, with VCTE <19.5 kPa who place a low value on the in­con­ve­nience and risks of en­doscopy, and a high value on avoid­ing the small risk of acute variceal hem­or­rhage as­so­ci­at­ed with VCTE val­ues of <19.5 kPa, may rea­son­ably se­lect to un­der­go screen­ing en­doscopy.

Cond

Low

Ev­i­dence for rec­om­men­da­tion 8

9

In pa­tients with sus­pect­ed chron­ic liver dis­ease un­der­going elec­tive non­hep­at­ic surgery, the AGA sug­gests a VCTE cut­off of 17.0 kPa to de­tect clin­i­cal­ly sig­nif­i­cant por­tal hy­per­ten­sion to in­form pre­op­er­a­tive care.
Com­ment: Pa­tients, par­tic­u­lar­ly those at high­er risk, with VCTE <17.0 kPa who place a low value on the in­con­ve­nience and risks of in­ter­ven­tions (en­doscopy, hep­at­ic ve­nous pres­sure gra­di­ent mea­sure­ment) to de­tect clin­i­cal­ly sig­nif­i­cant por­tal hy­per­ten­sion, and a high value on avoid­ing the small risk of op­er­a­tive mor­bid­i­ty and mor­tal­i­ty as­so­ci­at­ed with elec­tive non­hep­at­ic surgery, may rea­son­ably se­lect to un­der­go screen­ing en­doscopy.

Cond

Low

Ev­i­dence for rec­om­men­da­tion 9

10

In adult pa­tients with chron­ic hep­ati­tis C, the AGA sug­gests using VCTE rather than MRE for de­tection of cir­rhosis.

Cond

V Low

Ev­i­dence for rec­om­men­da­tion 10

11

In adults with NAFLD and a high­er risk of cir­rhosis, the AGA sug­gest using MRE, rather than VCTE, for de­tection of cir­rhosis.

Cond

Low

In adults with NAFLD and a lower risk of cir­rhosis, the AGA makes no rec­om­men­da­tion re­gard­ing the role of MRE or VCTE for de­tection of cir­rhosis.
Com­ment: High-‍risk pop­u­la­tions are NAFLD with ad­vanced age, obe­si­ty, par­tic­u­lar­ly cen­tral adi­pos­i­ty, di­a­betes, ala­nine el­e­vat­ed >23 upper limit of normal with an es­ti­mat­ed cir­rhosis preva­lence of 30% (typ­i­cal­ly seen in a re­fer­ral set­ting); low-‍riskpop­u­la­tion are those with NAFLD and signs of fatty liver on imag­ing only and an es­ti­mat­ed cir­rhosis preva­lence of ≤5% (typ­i­cal­ly seen in a pri­ma­ry care set­ting).

N/A

N/A

Ev­i­dence for rec­om­men­da­tion 11

SoR: Strength of Rec­om­men­da­tion
QoE: Qual­i­ty of Ev­i­dence
Strong: Strong Rec­om­men­da­tion
Cond: Con­di­tion­al Rec­om­men­da­tion
High: High-‍Qual­i­ty Ev­i­dence
Mod: Mod­er­ate-Qual­i­ty Ev­i­dence
Low: Low-‍Qual­i­ty Ev­i­dence
V Low: Very Low-‍Qual­i­ty Ev­i­dence