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
Position Statements
British Society of Gastroenterology and Association of Coloproctology of Great Britain and Ireland position on tranexamic acid in upper and lower gastrointestinal bleeding
clinical-resource/Tranexamic-acid-in-upper-lower-GI-bleeding
Following a concern raised to NHS England’s National Patient Safety Team regarding tranexamic acid use in gastrointestinal bleeding, and in light of the 2020 publication of the HALT-IT trial results,
Guidance
BSG Nurses Association
Endoscopy
BSG, ACPGBI and AUGIS guidance on the scope of professional practice for clinical endoscopists
clinical-resource/Guidance-on-practice-for-clinical-endoscopists
This document focuses on the scope of professional practice for clinical endoscopists (previously known as non- medical endoscopists/nurse endoscopists).