EASL Clinical Practice Guidelines

Methodology

These Clinical Practice Guidelines (CPGs) have been developed by a panel of experts chosen by the EASL and ALEH Governing Boards. The recommendations were peer-reviewed by external expert reviewers and approved by EASL and ALEH Governing Boards. The CPGs were established using data collected from PubMed and Cochrane database searches. The CPGs have been based, as far as possible, on evidence from existing publications, and, if evidence was unavailable, the experts' provide personal experiences and opinion. When possible, the level of evidence and recommendation are cited. The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations thus reflects the quality of underlying evidence. The principles of the GRADE system have been enunciated [20]. The quality of the evidence in the CPG has been classified into one of three levels: high (A), moderate (B) or low (C). The GRADE system offers two grades of recommendation: strong (1) or weak (2) (Table 1). The CPGs thus consider the quality of evidence: the higher the quality of evidence, the more likely a strong recommendation is warranted; the greater the variability in values and preferences, or the greater the uncertainty, the more likely a weaker recommendation is warranted.

Table 1
Evidence grading used for the EASL-ALEH guidelines (adapted from the GRADE system).

The non-invasive tests CPG Panel has considered the following questions:

  • What are the currently available non-invasive tests?
  • What are the endpoints for staging liver fibrosis?
  • How do serum biomarkers perform for staging liver fibrosis?
  • Do patented and non-patented serum biomarkers perform differently?
  • How does transient elastography (TE) perform for staging liver fibrosis?
  • How do novel elastography methods perform compared to TE for staging liver fibrosis?
  • How does TE perform compared to serum biomarkers for staging liver fibrosis?
  • What is the added value of combining TE and serum biomarkers?
  • What are the indications for non-invasive tests for staging liver disease in viral hepatitis?
  • What are the indications for non-invasive tests for staging liver disease in non-alcoholic fatty liver disease (NAFLD)?
  • What are the indications for non-invasive tests for staging liver disease in other chronic liver diseases?
  • How should non-invasive tests be used when deciding for treatment in viral hepatitis?
  • Is there a use for non-invasive tests when monitoring treatment response in viral hepatitis?
  • Is there a use for non-invasive tests when monitoring disease progression in chronic liver diseases?
  • What is the prognostic value of non-invasive tests in chronic liver disease?