Background: Home parenteral nutrition (HPN) associated liver disorder remains a major metabolic complication that may requires liver-intestine or multivisceral transplantation in some cases.The decision about the timing and the type of transplantation depends on the degree of liver fibrosis, whose evaluation requires liver histology. Although hepatic biopsy is the gold standard for detecting liver fibrosis, it is an invasive procedure with some complications. Therefore, noninvasive methods as a Fibroscan were developed to assess liver fibrosis. The goal of this study was to compare liver biopsy and Fibroscan in the evaluation of liver changes in patients with intestinal failure in HPN.

Methods: Inclusion criteria:Patient with short bowel syndrome using HPN for at least six months who underwent liver biopsy.In each patient we evaluated: characteristic of HPN, underlying disease, gut anatomy; clinical assessment; biochemical work-up; liver biopsy; Fibroscan assessment (score of liver stiffness).Liver histologic fibrosis was scored according the Brunt classification (grade: 0 to 4).

Results: Eighteen patients were enrolled (07 women / 11 men, mean age: 37y.). Reasons for liver biopsy were altered hepatic enzymes (n =18 ). The median duration of HPN was 31 months (range 11-133). Indication for HPN was short bowel disease (chronic mesenteric ischemia n = 4; Crohn’s disease n = 4; complications of bariatric surgery n = 4; volvulus n = 3) and chronic intestinal pseudobstrution (n = 3).Liver histology showed severe fibrosis (Brunt stage > 2) in 5 patients (28%) Abnormal Fibroscan score (F >3) was observed in 5 patients (28%). The results of liver disease graduation are presented in Table 1.Statistical analysis by Concordance Kappa was evaluated and no correlation was observed between Fiboscan and liver biopsy ( p <0,238).

Conclusion: No correlation was observed between Fiboscan and liver biopsy in patients on HPN due to short bowel disease.