S2590 Office-Based Liver Screening Identifies Undiagnosed Disease Progression in Patients Referred for Non-Liver Indications

Introduction: Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease, with potential to progress to fibrosis, cirrhosis, and liver cancer. Despite growing prevalence, population-wide screening is not standardized, and liver disease is often undetected due to referral patterns focusing on other concerns. Early detection and intervention can alter disease trajectory and improve outcomes. This study evaluated a liver screening initiative at a gastroenterology office, comparing liver disease prevalence between patients referred for liver concerns and those referred for other indications to assess whether broader screening could close diagnostic gaps. Methods: Patients at a gastroenterology office were screened over 36 months using vibration-controlled transient elastography (VCTE; FibroScan), a noninvasive, point-of-care tool for assessing liver fibrosis and steatosis. Medicaid patients were referred for mixed general GI and liver-related evaluation. Non-Medicaid patients, including those with commercial insurance or Medicare, were referred for non-liver concerns and screened at the provider’s discretion based on risk factors. Demographic and clinical data was collected prospectively. Results: A substantial number of patients - both referred for liver disease reasons and not - had clinically meaningful pathology. Across 1,211 patients (Medicaid = 723; non-Medicaid = 488), advanced fibrosis (kPa ≥8.0) was detected in 16.2% of non-Medicaid patients, compared to 23.8% of Medicaid patients (P = 0.0012). Stage ≥2 steatosis (CAP scores >268) was also common in both groups (62.7% non-Medicaid vs 68.6% Medicaid; P = 0.01). Medicaid patients were significantly younger (56.5% under age 50 vs 29.3%; P < 0.00001) and more likely to have obesity (BMI >35 in 27.8% vs 16.4%; P < 0.00001). Scan quality was unaffected by BMI, supporting screening applicability across populations. Conclusion: More standardized screening practices can improve early detection, as screening patients - regardless of referral reason - can identify undiagnosed liver disease, including fibrosis and steatosis. Noninvasive technologies make routine assessment more feasible in outpatient settings and hold promise for improving care access and equity. Future work should further evaluate the long-term impact of routine liver screening and assess potential implementation strategies.