Physicians' practices for diagnosing liver fibrosis in chronic liver diseases: a nationwide, Canadian survey.
Canadian journal of gastroenterology & hepatology
Sebastiani G, Ghali P, Wong P, Klein MB, Deschenes M, Myers RP
2014 Can J Gastroenterol Hepatol Volume 28 Issue 1
To determine practices among physicians in Canada for the assessment of liver fibrosis in patients with chronic liver diseases.
Hepatologists, gastroenterologists, infectious diseases specialists, members of the Canadian Gastroenterology Association and⁄or the Canadian HIV Trials Network who manage patients with liver diseases were invited to participate in a web-based, national survey.
Of the 237 physicians invited, 104 (43.9%) completed the survey. Routine assessment of liver fibrosis was requested by the surveyed physicians mostly for chronic hepatitis C (76.5%), followed by autoimmune⁄cholestatic liver disease (59.6%) and chronic hepatitis B (52.9%). Liver biopsy was the main diagnostic tool for 46.2% of the respondents, Fibroscan (Echosens, France) for 39.4% and Fibrotest (LabCorp, USA) for 7.7%. Etiology-specific differences were observed: noninvasive methods were mostly used for hepatitis C (63% versus 37% liver biopsy) and hepatitis B (62.9% versus 37.1% liver biopsy). For 42.7% of respondents, the use of noninvasive methods reduced the need for liver biopsy by >50%. Physicians' characteristics associated with higher use of noninvasive methods were older age and being based at a university hospital or in private practice versus community hospital. Physicians' main concerns regarding noninvasive fibrosis assessment methods were access⁄availability (42.3%), lack of guidelines for clinical use (26.9%) and cost⁄lack of reimbursement (14.4%).
Physicians who manage patients with chronic liver diseases in Canada require routine assessment of liver fibrosis stage. Although biopsy remains the primary diagnostic tool for almost one-half of respondents, noninvasive methods, particularly Fibroscan, have significantly reduced the need for liver biopsy in Canada. Limitations in access to and availability of the noninvasive methods represent a significant barrier. Finally, there is a need for clinical guidelines and a better reimbursement policy to implement noninvasive tools to assess liver fibrosis.