Users stories: interview with Stephen Esposito

Basically, anything involving the liver. We use it with fatty liver (NAFLD), hepatitis B, hepatitis C, alcoholic liver disease, NASH, some of the auto-immune diseases, and for patients with hemochromatosis. FibroScan^® is a simple, safe and cost-effective screening test for us.

The first thing that’s important to me, for all of the patients in our practice, is to get a baseline—for all my liver patients. From there, you may have different questions for each disease: For example, with HCV patients, we use FibroScan® to approve anti-viral medicines, even though many states have dropped the fibrosis requirement, we’ve seen much faster approvals for anti-virals when we include the FibroScan^® results versus a blood test alone.
With HBV patients, you’ll face a different scenario. Their lab results may reveal normal ALT, negative HBV EAg, and their fibrosis may be very variable. We can use FibroScan^® data to decide which patients may benefit from the administration of antiviral medicines.

When we can actually measure how much fibrosis is present with a patient, we can determine those who may be at higher risk for other conditions. So, for example, I might recommend closer screenings for hepatocellular carcinoma, or we might want to do an endoscopy to look for portal hypertension. When I see a heightened stiffness score – say 20 kPa or above – I know that this patient is at risk for a liver-averse event. I can’t tell you how many times we’ve seen someone with a normal platelet count have significant fibrosis. FibroScan^® helps identify high-risk patients that you wouldn’t discover otherwise. Up to 60% of our NASH patients have normal liver enzymes. It may be difficult without a liver biopsy or a FibroScan^® to know the status of their liver disease.

I think that our patients find it very encouraging, on the whole. If we have a patient with SVR, for example, we can track a progression of their fibrosis. I think they find it very encouraging to see a concrete metric showing their liver is getting better.

Historically, the majority of our patients come from PCPs, but I’m starting to get a higher number of other gastroenterologists referring specific patients as well. I think those doctors are beginning to understand the advantages of the FibroScan^® exam – and I try to reassure them that the patients will return to them for their endoscopies or colonoscopies. With our FibroScan^®, we have also noticed increases in our radiology practice, as we work to catch disease states sooner. We now have a sonogram tech who visits the practice twice weekly.
Overall, I think we’ve tracked an increase in patient volume of maybe 10% or 15%, most notably, we have seen an increase in endoscopic procedures

Honestly, I can’t imagine my life without a FibroScan^® now. I don’t know how we practiced without it. It has really changed my workup of a patient. In some cases, it’s become more important, to me, than an endoscopy. It has improved our entire practice in the sense that I feel more comfortable knowing which patients we need to worry about, which patients require frequent re-calls and so forth.
And I believe that physicians and payers are coming to understand the benefits of it as well. This diagnostic test will pick out people at high risk that no other routine test is going to find, unless you’re going to CT scan every patient. If you think about it, if you uncover that one cirrhotic liver, you save that one trip to the ER with a variceal bleed, you understand how beneficial that can be.