S2420 Using Fibroscans to Measure Clinically Significant Portal Hypertension in Patients With Hepatocellular Carcinoma

Introduction: Education regarding updated guidelines is an important process in medicine today. Previously, Hepatocellular Carcinoma (HCC) patients were treated with a non-selective beta blocker (NSBB) if they had known portal hypertension confirmed with variceal visualization on endoscopy. Now after Baveno VII it is recommended to screen all HCC patients for clinically significant portal hypertension (CSPH) and if present to start prophylactic NSSB treatment. The primary goal is to prevent or delay high risk variceal bleeding. Fibroscans are an ultrasound elastography study which measures liver stiffness (LSM) and remains the preferred method to measure CSPH since they are noninvasive and readily available. An LSM >25 kPA or LSM >20 kPA with a platelet count <150 K/mm3 is highly specific for CSPH. To educate patients on updated guidelines and order CSPH screening. Methods: This is the second part of a 3-part initiative in a suburban resident-run primary care clinic serving veterans. The first part, as previously published, was to query patients with HCC, identify patients who were eligible for screening, and educate their primary care physician about the new Baveno VII criteria. Thirty-nine patients were identified with HCC; 23 were determined to need further screening. These patients' charts were reviewed and if necessary, contacted by phone to discuss CSPH and appropriate screening; If amendable, Fibroscans were ordered. Results: Twenty-three male patients or 53% of the original cohort were identified for needing further CSPH screening. On chart review, 13 of the 23 patients were determined to be still eligible for contact. Inclusion criteria were patients who met criteria for history of HCC and did not undergo successful transplantation. Exclusion criteria were successful transplantation, already started on NSBB, placed on hospice or death since the start date of the study. The 13 remaining patients were contacted by phone and educated on Fibroscan screening. Ten were successfully contacted, and 9 of which were willing to undergo the scan. One patient felt his prognosis was too poor for the scan to be worthwhile. Conclusion: This initiative is working on improving medical management and screening for CSPH in patients with HCC. It highlights the need for continued education of updated guidelines and the importance of shared decision making with patients. Furthermore, it underscores the importance of a multidisciplinary team to stay current in the ever-changing landscape of modern medicine.