P80 Ultrasound practice is heterogeneous and failing to highlight clinically significant liver disease

Damien Leith, Stephen T. Barclay, Raj Burgul, Peter Hayes, Mathis Heydtmann, Morag Stout, Dilip Patel, Joanna Leithead

Research output: Contribution to conferenceAbstract


Introduction Abdominal ultrasound [US] is recommended in the initial investigation of patients with abnormal liver function tests [LFT] (BSG guidelines, Newsome et al 2017); however there is a paucity of guidance for US practice in this setting with implications for disease identification. Our aim was to review terminology and practice of the outpatient “abnormal LFT” US, and its efficacy in the risk stratification of liver disease.
Methods A Scotland wide service evaluation on behalf of the Scottish Society of Gastroenterology in collaboration with the Scottish Radiological Society of all adult outpatient US scans performed for the indication “abnormal LFTs” 04-17/10/21.
Results 515 US scans were reviewed from 11/14 Health Boards. 69% of scans were requested by Primary Care; 78% were performed by a Radiographer.
There was significant variability in descriptive terminology and parameters reported – this variability was not influenced by hospital type, requesting information or scan findings; and instead related to teaching deanery - on adjusted analyses the North (p<0.001, p<0.001) and West deaneries (p<0.001, p=0.002) were less likely to describe the liver edge and portal vein. of the 281 scans reporting “fatty liver”, incomplete information was provided to risk stratify in 76%: the liver edge, absolute spleen size and presence/absence of ascites were described in only 40%, 15% and 55%, respectively. Overall, 45 scans (9%) reported characteristics very suggestive of cirrhosis, but the word “cirrhosis” was mentioned in only 5 of these scans (11%) and referral to Gastroenterology recommended in only 1 - meaning at least 884 missed opportunities to diagnose cirrhosis/year.
The results suggest a crude incidence of fatty liver of 141/100,000/year and a crude incidence of cirrhosis of 22/100,000/year; however there was significant variability across Health Boards (range 0-381 and 0-62/100,000/year, respectively). The crude incidence did not relate to the reported crude prevalence of type 2 diabetes mellitus or alcohol related mortality rate, and instead increased with the number of scans performed/100,000 population.
Conclusions US practice is heterogeneous and failing to highlight clinically significant disease during the work up of abnormal LFTs. Our results emphasise the need for standardisation of reporting and referral pathways.
Original languageEnglish
Number of pages1
Publication statusPublished - 27 Mar 2024
EventBritish society of Gastroenterology: Annual meeting 2022 - ICC, Birmingham, United Kingdom
Duration: 20 Jun 202223 Jun 2022


ConferenceBritish society of Gastroenterology
Abbreviated titleBSG Live 2022
Country/TerritoryUnited Kingdom
Internet address


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