P4778 - To Screen or Not to Screen, That is the Question

Saddam Zaidi, MD¹, Cheng-Hung Tai, MD², Caroline Loeser, MD^2
1Bridgeport Hospital, Trumbull, CT; ²Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT

Introduction: AASLD and EASL recommend biennial HCC screening for patients with Child-Pugh scores A and B, but not C. We present a 43-year-old female with alcohol-related hepatitis and cirrhosis. Despite an initial Fibrotest score of F4 in 2021, her score improved to F2 by 2023 with strict alcohol abstinence. AASLD guidelines for HCC screening in such scenarios remain unclear.

Case Description/Methods: A 43-year-old female with alcohol use disorder presented with worsening abdominal pain, jaundice, and abdominal distension. Labs revealed total bilirubin 20.5 mg/dL, AST 82 U/L, ALT 23 U/L, and ALP 434 U/L. A CT scan showed a cirrhotic liver and portal hypertension. Liver biopsy confirmed fatty changes, Mallory-Denk bodies, and fibrosis indicative of alcoholic hepatitis. Both FibroTest and FibroScan indicated advanced fibrosis (F4). On outpatient follow-up, repeat FibroTest and FibroScan showed significant improvement, with scores dropping to F1-2 and F2, respectively. Liver function tests returned to normal. She continues to follow up in outpatient hepatology clinic, undergoing HCC screening every 6 months.

Discussion: This case emphasizes the complexities in managing HCC surveillance in patients with alcoholic liver disease who show significant biochemical and histological improvement. The patient's improvement from advanced fibrosis (F4) to a milder stage (F1-2) within two years, along with normalization of liver function tests, illustrates potential for liver regeneration and healing through strict alcohol abstinence. Research supports that sustained abstinence can lead to fibrosis and even cirrhosis regression, enhancing overall liver function and prognosis.

Despite these improvements, current AASLD and EASL guidelines mandate biennial HCC screening for patients with Child-Pugh A and B scores due to the persistently elevated risk of HCC. The Child-Pugh score remains the standard for guiding surveillance strategies. These guidelines do not address management changes based on fibrosis score improvements, as indicated by tests like FibroTest or FibroScan. This highlights the need for more nuanced guidelines that incorporate fibrosis regression when planning HCC surveillance. Current recommendations emphasize surveillance based on the Child-Pugh score, reflecting the persistent risk of HCC in cirrhotic patients. Future guidelines could be improved by integrating fibrosis regression into their surveillance algorithms, allowing for a more individualized approach to patient care.


Disclosures:


Saddam Zaidi, MD¹, Cheng-Hung Tai, MD², Caroline Loeser, MD². P4778 - To Screen or Not to Screen, That is the Question, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.