The evidence supports the routine adoption of a change to the Enhanced Liver Fibrosis (ELF) test score cut-off from 10.51 to 9.8 to diagnose advanced fibrosis (AF) in people with metabolic dysfunction-associated steatotic liver disease (MASLD) in any healthcare setting. Evidence for use of a two-step pathway using the Fibrosis-4 (FIB-4) index, followed by an ELF test for people with an indeterminate FIB-4 score in primary care, is promising, but insufficient to support routine adoption. Evidence exists for the diagnostic accuracy of the ELF test at a cut-off of 9.8 to diagnose AF in people with MASLD. Use of a two-step pathway may reduce unnecessary referrals to secondary care. Health economic assessment estimates that reducing the ELF test cut-off from 10.51 to 9.8 is likely to be cost effective, with an incremental cost-effectiveness ratio of £14,842 per quality-adjusted life year gained. Cost effectiveness remained in a scenario reducing the ELF test cut-off in a two-step pathway following an indeterminate FIB-4.
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Clinical Resources
Guidance
Small Bowel and Nutrition
BAPEN Position Statement on Electrolyte and Vitamin Replacement in Adult patients with severe malnutrition, including people with Eating Disorders and other conditions who are undergoing refeeding
clinical-resource/BAPEN-Electrolyte-Vitamin-Replacement
This guidance has been endorsed by the BSG, and was published in 2025.
Clinical Resources Categories
Liver
Venesection treatment in haemochromatosis – current best practice from the BSG/BASL Special Interest Group
clinical-resource/Venesection-treatment-in-haemochromatosis
Haemochromatosis is the most common single gene disorder affecting the population of the UK, resulting in iron overload and organ damage.