Liver assessment during screening colonoscopy identifies undetected steatosis

This prospective cross-sectional study evaluated whether non-invasive liver assessment could be integrated into screening colonoscopy visits for adults aged 50 years or older without known chronic liver disease. Participants underwent hepatic ultrasound and point shear wave elastography; the researchers assessed feasibility, acceptance, and detection of elevated liver stiffness, as well as risk-factor criteria and the Fibrosis-4 (FIB-4) index.

Of 692 people offered participation, 610 enrolled (88.2%); one was excluded, and reliable stiffness measurements were obtained in 578 of the remaining 609 participants (94.9%). Ultrasound-defined steatosis was found in 55.5%. Liver stiffness was at least 1.50 m/s in 9.0% and at least 1.70 m/s in 5.0%. Risk-factor criteria identified 46 of 52 participants with stiffness of at least 1.50 m/s. At that threshold, FIB-4 had modest discrimination (AUROC 0.682); sensitivity was lower with age-adjusted than with a single threshold (0.529 vs 0.706).

The findings suggest that assessment during colonoscopy is feasible and can detect previously unrecognized liver abnormalities in this population. However, the cross-sectional study used stiffness thresholds rather than clinical outcomes, and does not establish whether this approach improves diagnosis, management, or patient outcomes.