Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis
Open accessAbstract
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.)
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A marked increase in LSM may be related to the development of bile duct obstruction.
“a marked increase in LSM may be related to the development of bile duct obstruction.110”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [110]
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- Authors
- Millonig, G., Reimann, F. M., Friedrich, S., Fonouni, H., Mehrabi, A., Büchler, M. W., Seitz, H. K., & Mueller, S.
- Affiliations
- Heidelberg University (DE)
- Corresponding author
- Mueller, Sebastian
- Venue
- Hepatology
- Published
- 2008-11
- Volume
- 48
- Issue
- 5
- Pages
- 1718-1723
- ISSN
- 0270-9139 (ISSN-L)
- OpenAlex
- W2166947839
- Cited by
- 599
- References
- 19
- Citations by year
- 2026: 7 · 2025: 19 · 2024: 18 · 2023: 26 · 2022: 25 · 2021: 40 · 2020: 45 · 2019: 41 · 2018: 29 · 2017: 46 · 2016: 38 · 2015: 51 · 2014: 51 · 2013: 45 · 2012: 37
- FWCI
- 20.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Ultrasound Imaging and Elastography
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- extrahepatic cholestasis, liver stiffness, transient elastography, liver fibrosis, biliary drainage, bilirubin, liver cirrhosis, bile duct ligation, liver metastasis, noninvasive fibrosis assessment
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cholestasis, Extrahepatic, Bile Ducts, Female, Gastrointestinal Neoplasms, Humans, Liver, Liver Cirrhosis, Male, Middle Aged, Pancreatic Neoplasms, Stomach Neoplasms, Tomography, X-Ray Computed, Jaundice, Obstructive, Elasticity Imaging Techniques
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