Structured Early detection of Asymptomatic Liver Cirrhosis: Results of the population-based liver screening program SEAL

Signed, SEALed, detected I’m your patient with advanced fibrosis or cirrhosis!

“…This latter challenge was demonstrated in the SEAL study, where alarmingly only 49.2% of patients identified to be at high risk of advanced fibrosis or cirrhosis actually showed up for their follow-up outpatient hepatology appointment. 2 This disappointing lack of interest or appreciation of importance was similarly reported in a Welsh study presented at the ILC in 2020. 6 In that study of "reflex" AST testing, patients who had an elevated ALT measured in primary care had AST measured too, and the AST:ALT ratio was computed and presented to the general practitioner.…”

“…This month's issue of the Journal of Hepatology presents the results of a German liver screening programme -"Structured Early detection of Asymptomatic Liver cirrhosis" (SEAL) -which highlights the potential benefits, but also the barriers that need to be overcome. 2 There are two main challenges to effective early cirrhosis detection: Firstly, there is little evidence that earlier diagnosis of advanced fibrosis or cirrhosis leads to a longer and/or better life. [3][4][5] Secondly, there seems to be a lack of engagement from patients and general practitioners.…”

“…The difference in prevalence between the SEAL and control cohorts (0.38% and 0.34%, respectively) was not statistically significant, and the number needed to screen to find one extra patient with advanced fibrosis or cirrhosis was 2,115. 2 Clinical significance may well be viewed differently from statistical significance, but costs still have to be considered. If the additional 1 of 2,115 patients benefited from an intervention that was life-transforming, the costs may be justified.…”

“…9 Furthermore, the investigators used coded diagnoses given in the period from one year before to one year after the Check-up 35 examination to determine whether a diagnosis of advanced fibrosis or cirrhosis was new, with this arbitrary timeframe leading to some existing diagnoses being falsely attributed as new diagnoses. 2 Despite its limitations, the SEAL study is important in that it firstly gives us an estimate of the prevalence of previously undetected chronic liver disease (2.1%) and advanced fibrosis or cirrhosis (0.38%) in members of the general population who choose to attend a general health check-up and a subsequent specialist workup. These estimates are on par with previous studies.…”

Psychometric properties of the German version of the Psychological Consequences of Screening Questionnaire (PCQ) for liver diseases

“…In Germany, a screening procedure called “Gesundheits-Check-Up” (health check-up) that aims to detect risk factors for certain diseases is available for statutory health insurance members aged 35 and higher and includes a blood and urine test ( Institute for Quality and Efficiency in Health Care, 2022 ). A newly introduced screening procedure using a calculated ratio for the early detection of cirrhosis or fibrosis of the liver was tested in the context of the SEAL program (SEAL – Structured early detection of asymptomatic cirrhosis of the liver in Rhineland-Palatinate and Saarland) in two German Federal States (Rhineland-Palatinate and Saarland) from January 2017 to October 2021 ( Nagel et al, 2019 ; Labenz et al, 2022 ). This program integrates the screening in the “Gesundheits-Check-Up” routine, which can be repeated every three years.…”