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Practice Guideline
. 2017 Jan;11(1):1-30.
doi: 10.1007/s12072-016-9760-3. Epub 2016 Oct 6.

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

Gamal Shiha  1   2 , Alaa Ibrahim  3 , Ahmed Helmy  4 , Shiv Kumar Sarin  5 , Masao Omata  6 , Ashish Kumar  7 , David Bernstien  8 , Hitushi Maruyama  9 , Vivek Saraswat  10 , Yogesh Chawla  11 , Saeed Hamid  12 , Zaigham Abbas  13 , Pierre Bedossa  14 , Puja Sakhuja  15 , Mamun Elmahatab  16 , Seng Gee Lim  17 , Laurentius Lesmana  18 , Jose Sollano  19 , Ji-Dong Jia  20 , Bahaa Abbas  21 , Ashraf Omar  22 , Barjesh Sharma  23 , Diana Payawal  24 , Ahmed Abdallah  25 , Abdelhamid Serwah  26 , Abdelkhalek Hamed  27 , Aly Elsayed  28 , Amany AbdelMaqsod  29 , Tarek Hassanein  30 , Ahmed Ihab  31 , Hamsik GHaziuan  32 , Nizar Zein  33 , Manoj Kumar  5
Affiliations
Practice Guideline

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

Gamal Shiha et al. Hepatol Int. 2017 Jan.

Abstract

Hepatic fibrosis is a common pathway leading to liver cirrhosis, which is the end result of any injury to the liver. Accurate assessment of the degree of fibrosis is important clinically, especially when treatments aimed at reversing fibrosis are being evolved. Despite the fact that liver biopsy (LB) has been considered the "gold standard" of assessment of hepatic fibrosis, LB is not favored by patients or physicians owing to its invasiveness, limitations, sampling errors, etc. Therefore, many alternative approaches to assess liver fibrosis are gaining more popularity and have assumed great importance, and many data on such approaches are being generated. The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on liver fibrosis in 2007, with a mandate to develop consensus guidelines on various aspects of liver fibrosis relevant to disease patterns and clinical practice in the Asia-Pacific region. The first consensus guidelines of the APASL recommendations on hepatic fibrosis were published in 2009. Due to advances in the field, we present herein the APASL 2016 updated version on invasive and non-invasive assessment of hepatic fibrosis. The process for the development of these consensus guidelines involved review of all available published literature by a core group of experts who subsequently proposed consensus statements followed by discussion of the contentious issues and unanimous approval of the consensus statements. The Oxford System of the evidence-based approach was adopted for developing the consensus statements using the level of evidence from one (highest) to five (lowest) and grade of recommendation from A (strongest) to D (weakest). The topics covered in the guidelines include invasive methods (LB and hepatic venous pressure gradient measurements), blood tests, conventional radiological methods, elastography techniques and cost-effectiveness of hepatic fibrosis assessment methods, in addition to fibrosis assessment in special and rare situations.

Keywords: Chronic liver disease; Cirrhosis; Graft fibrosis; Hepatitis B; Hepatitis C; Invasive assessment, non-invasive assessment; Liver fibrosis; Non-alcoholic steatohepatitis.

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