Article first published online: 14 AUG 2008
Copyright © 2008 American Association for the Study of Liver Diseases
Volume 48, Issue 5, pages 1718–1723, November 2008
How to Cite
Millonig, G., Reimann, F. M., Friedrich, S., Fonouni, H., Mehrabi, A., Büchler, M. W., Seitz, H. K. and Mueller, S. (2008), Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Hepatology, 48: 1718–1723. doi: 10.1002/hep.22577
Part of this study was presented as an oral presentation at the Digestive Disease Week meeting, San Diego, CA, May 17–22, 2008.
Potential conflict of interest: Nothing to report.
- Issue published online: 28 OCT 2008
- Article first published online: 14 AUG 2008
- Accepted manuscript online: 14 AUG 2008 12:00AM EST
- Manuscript Accepted: 8 AUG 2008
- Manuscript Received: 24 JUN 2008
- Dietmar Hopp Foundation
Transient elastography (FibroScan [FS]) is a novel non-invasive tool to assess liver fibrosis/cirrhosis. However, it remains to be determined if other liver diseases such as extrahepatic cholestasis interfere with fibrosis assessment because liver stiffness is indirectly measured by the propagation velocity of an ultrasound wave within the liver. In this study, we measured liver stiffness immediately before endoscopic retrograde cholangiopancreatography and 3 to 12 days after successful biliary drainage in patients with extrahepatic cholestasis mostly due to neoplastic invasion of the biliary tree. Initially elevated liver stiffness decreased in 13 of 15 patients after intervention, in 10 of them markedly. In three patients, liver stiffness was elevated to a degree that suggested advanced liver cirrhosis (mean, 15.2 kPa). Successful drainage led to a drop of bilirubin by 2.8 to 9.8 mg/dL whereas liver stiffness almost normalized (mean, 7.1 kPa). In all patients with successful biliary drainage, the decrease of liver stiffness highly correlated with decreasing bilirubin (Spearman's ρ = 0.67, P < 0.05) with a mean decrease of liver stiffness of 1.2 ± 0.56 kPa per 1 g/dL bilirubin. Two patients, in whom liver stiffness did not decrease despite successful biliary drainage, had advanced liver cirrhosis and multiple liver metastases, respectively. The relationship between extrahepatic cholestasis and liver stiffness was reproduced in an animal model of bile duct ligation in landrace pigs where liver stiffness increased from 4.6 kPa to 8.8 kPa during 120 minutes of bile duct ligation and decreased to 6.1 kPa within 30 minutes after decompression. Conclusion: Extrahepatic cholestasis increases liver stiffness irrespective of fibrosis. Once extrahepatic cholestasis is excluded (e.g., by liver imaging and laboratory parameters) transient elastography is a valuable tool to assess liver fibrosis in chronic liver diseases. (HEPATOLOGY 2008.)