1. Fatty liver disease with fibrosis and inflammation. Long term study (18+ months)with oral medication, called Obeticholic Acid. Enrolling now, call 415 3532012 (Nora is the coordinator) or 6415430 (Dr Bonacini). A liver biopsy is needed to enter the study.

2. NASH with stages 3 or 4 Fibrosis: Oral medication (Selonsertib) for 18+ months. Liver biopsy needed to enter the study.

 3. Fatty liver disease with fibrosis and inflammation. SHORT  term study (16 weeks total) with oral  medication, which improves fibrosis and fat content in the liver. Enrolling now, call 415 3532012 (Nora is the coordinator) or 6415430 (Dr Bonacini). A liver biopsy is NOT needed to enter the study


Mission Gastroenterology and Hepatology has been offering the Fibroscan™ since June 30, 2014. The Fibroscan™ is a bedside machine, which measures liver fibrosis non invasively. This innovative and ground breaking modality has been evaluated in more than 400 peer-reviewed articles in hepatitis B, C as well as fatty liver disease. In April 2013, the Food and Drug Administration approved its use in the U.S.A. Fibroscan™ is a painless, rapid test (about 15 minutes) which can
be used to classify patients in terms of the severity of their liver fibrosis.

How does it work?

A painless "shear waves" is created by the Fibroscan™ machine over the patient’s skin.
A computer, based on ultrasound, measures the elasticity of the liver using a technique
called Vibration-Controlled Transient Elastography (VCTE™). The measurement unit is the
kPa (kilopascals): the higher the number, the more advanced is the liver fibrosis. It is
important to recognize that the stiffness levels vary according to the type of liver disease.
For example, the cutoff for cirrhosis is lower in hepatitis C and higher for alcoholic liver

Liver biopsy is an imperfect gold standard to assess and stage fibrosis in the liver.
In addition, there are several major disadvantages to the biopsy:

1.    it is an invasive test
2.    it requires the patient to be hospitalized for half a day
3.    it is expensive
4.    it is associated with certain risks, such as pain (20%) and bleeding (1%) which
sometimes require hospitalization

5.    Death has been reported in 1/10,000 biopsies
6.    In addition, a liver biopsy samples only a very small piece of the liver, which can
lead to incorrect staging if this sample is not representative of the rest of the liver. Thus,
liver biopsy can lead to sampling error, which may result in understaging of fibrosis;
sampling error may occur in up to 25-30% of liver biopsies. Another limitation of liver biopsy
is that different pathologists can interpret the same sample differently, which can result in discrepancies in liver disease staging.

Fibroscan™ offers several advantages compared to liver biopsy:

1. It is a noninvasive test, and it can be performed in our office at the end of the visit
2. There is no pain, and sedation is not required
3. The test takes only 15 minutes to perform
4. It is significantly less expensive than liver biopsy
5. It hasn’t been associated with any side effects

However, Fibroscan™ does have some limitations:

1. It is not as accurate as needle biopsy for those with mid-level liver disease
2. It is not advised for patients with ascites, and/or morbid obesity
3. It is best interpreted when patients have been fasting for at least 3 hours