Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

Liver stiffness measurement using FibroScan is a novel rapid and non-invasive technique that evaluates liver fibrosis. In some cases, however, no elasticity measurement is obtained. The aim of this prospective study was to assess the prevalence and factors associated with failure (no value obtained after 10 measurements) of liver stiffness measurement in patients with chronic liver disease. Two thousand one hundred and fourteen liver stiffness measurements were analyzed. Failure was observed in 96 cases (4.5%). Failure was not associated with operator, gender, or transaminase level. By multivariate analysis, the only factor associated with failure was body mass index greater than 28 (odds ratio, 10.0 degrees; 95% confidence interval, 5.7-17.9, P=0.001). In conclusion, liver stiffness is a good method for the evaluation of liver fibrosis that is feasible in more than 95% of patients. Other non-invasive methods such as biochemical methods or liver biopsy could therefore be used only in patients with failure of FibroScan examination.

No abstract

SIRT seems more effective than sorafenib in patients presenting with HCC and tumoural PVT. This hypothesis is being tested in prospective randomized trials.

Summary Background Methotrexate is an effective treatment in Crohn's disease, which may induce liver fibrosis with high cumulative doses. Transient elastography (FibroScan, Echosens, Paris, France) is a new non‐invasive rapid, allowing assessment of liver fibrosis by measurement of liver stiffness. Aim A prospective study to evaluate liver fibrosis with FibroScan and non‐invasive biochemical methods in Crohn's disease patients treated with methotrexate. Methods Consecutive Crohn's disease patients had evaluation of liver fibrosis with non‐invasive methods. Two subgroups of patients were compared: cumulative dose of methotrexate of more than 1500 mg (group 1) and naive for methotrexate (group 2). Liver biopsy was performed in patients with persistent liver enzyme abnormalities or FibroScan value >8.7 kPa. Results Fifty‐four consecutive Crohn's disease patients were fully investigated (45 females, mean age 41 ± 14 years). Median FibroScan values were similar in group 1 (n = 21) and in group 2 (n = 33), 5.5 and 4.5 kPa, respectively. FibroScan values were not correlated with the cumulative dose of methotrexate. Conclusion In Crohn's disease patients treated with a high dose of methotrexate, significant liver fibrosis is rare and not accurately detected with liver enzymes abnormalities. FibroScan could be recommended and liver biopsy could be performed only with patients with high values and/or with chronic liver enzymes abnormalities.