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The recent article by Abeysekera et al provides valuable insights into the evolving attitude towards non-invasive fibrosis testing (NIT) in the UK.1 By comparing two surveys conducted among gastroenterology and hepatology specialists in 2014–2015 and 2021, the authors shed light on the changing landscape in this field. The results of the study are encouraging and point towards progress.
One notable finding is that almost all the clinicians surveyed now routinely perform fibrosis assessment, indicating a widespread acceptance of non-invasive testing methods. This marks a positive shift away from the traditional reliance on liver biopsies for fibrosis staging, which has been associated with limitations and risks. Transient elastography has remained the favoured NIT among specialists and is being used frequently as a reliable alternative to biopsy. There has been a rise in the use of indirect fibrosis biomarkers, such as FIB-4 and the non-alcoholic fatty liver disease (NAFLD) fibrosis score, which are routinely available and can reliably exclude advanced fibrosis. Use of these tests can help rationalise the use of transient elastography, which remains a limited resource in many areas. This work has also shown that most gastroenterologists and hepatologists now view NITs as suitable alternatives for both staging liver fibrosis and assessing prognosis. Liver biopsy is now primarily being reserved for cases of diagnostic uncertainty, suspected autoimmune hepatitis or situations where there is discordance between NITs and the clinical presentation. Overall, this trend indicates that clinicians are embracing less invasive approaches for fibrosis assessment.
Given the progress in the adoption of NITs to …
Contributors Commentary jointly written by JS and SM.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SM is chair of the BASL/BSG NAFLD Special Interest Group and was co-lead of the UK National Audit on NAFLD. He is also chief investigator of the SOLID study, which is evaluating the use of non-invasive fibrosis biomarkers at the primary-secondary care interface. JS has no conflict of interest.
Provenance and peer review Not commissioned; internally peer reviewed.