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Non-Alcoholic Fatty Liver DiseaseNCT05728697

Endoscopic Ultrasound Shear Wave Elastography in Patients With Non-alcoholic Fatty Liver Disease

An observational study of Non-Alcoholic Fatty Liver Disease and Non-alcoholic Steatohepatitis, run by Brigham and Women's Hospital at 2 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this observation study is to assess whether endoscopic ultrasound shear wave elastography (EUS-SWE) may be a useful tool for liver fibrosis screening in patients with elevated body mass index and non alcoholic fatty liver disease as compared to other non-invasive screening modalities, which have… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Endoscopic ultrasound shear wave elastography
Type of treatment
Medical device
How many people
150 participants
Where
2 sitesUnited States
Study dates
1 Jun 2021to Jan 2027
How long will I take part?
1 Week
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Adults who are overweight or obese with suspected or confirmed NAFLD/NASH planned for clinically indicated EUS with liver biopsy

Who may be able to join

  • Adults 18 years or older
  • Planned for clinically indicated endoscopic ultrasound with plan for follow up liver biopsy
  • Suspected or confirmed non alcoholic fatty liver disease prior to procedure
  • Body mass index >=25

Who cannot join

  • Inadequate liver biopsy sample

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Peter Konyn, MD contact

6177325500

pkonyn@bwh.harvard.edu

United States2 sites, 2 recruiting
  • Brigham and Women's Hospital

    Boston, Massachusetts, 02115

    Michele Ryan, MS, 6177325500, mryan@bwh.harvard.edu

    Peter Konyn, MD, 6177325500, pkonyn@bwh.harvard.edu

    Recruiting
  • Brigham and Women's Faulkner Hospital

    Boston, Massachusetts, 02130

    Peter Konyn, MD, 6177325500, pkonyn@bwh.harvard.edu

    Marvin Ryou, MD

    Recruiting

Other trials in United States

About this study

Official title: Endoscopic Ultrasound Shear Wave Elastography: A Novel Tool for Fibrosis Screening in Patient With Elevated Body Mass Index and Suspected Non-Alcoholic Fatty Liver Disease or Steatohepatitis

The goal of this observation study is to assess whether endoscopic ultrasound shear wave elastography (EUS-SWE) may be a useful tool for liver fibrosis screening in patients with elevated body mass index and non alcoholic fatty liver disease as compared to other non-invasive screening modalities, which have traditionally had less accurate results in this population.

The main questions it aims to answer are:

Read more
  • Determine accuracy of EUS-SWE for liver fibrosis screening compared to other non-invasive scoring systems, such as the FIB-4 score and Fibroscan in patients with elevated body mass index
  • Establish optimal stiffness (kPa) cutoffs for liver fibrosis grading for EUS-SWE for this patient population in reference to the gold standard liver biopsy, as no standard cutoffs currently exist.

Participants will undergo routine endoscopic ultrasound as part of their standard clinical care and indication. Participants are consented for the procedure and undergoing the shear wave elastography. In addition to their standard ultrasound test, it takes on average an extra 2-3 minutes to perform the shear wave elastography. The procedure itself adds no additional risk to the patient and does not expose them to radiation.

Read the detailed description

Introduction:

Non-alcoholic fatty liver disease (NAFLD) is the most widespread chronic liver condition across the world. NAFLD over time can progress to its more severe form, non-alcoholic steatohepatitis (NASH), which is associated with increased speed of progression to advanced fibrosis and cirrhosis. Identification of patients with suspected NAFLD/NASH and early stage fibrosis is crucial for prompt clinical management in weight loss and optimization of metabolic disorders for reversal of fibrosis, but the gold standard of liver biopsy can be impractical due to high costs and risk of sampling error and procedural complications.

Elastography is a non-invasive imaging modality that provides information about tissue elasticity and is often used to measure liver stiffness as a correlation to fibrosis severity (F0-4). Elastography has been heralded as a promising alternative to liver biopsies given its non-invasive nature and improved cost effectiveness in the general population. Many elastography modalities exist, including Fibroscan, magnetic resonance elastography (MRE), and shear wave elastography (SWE).

Unfortunately, despite being highly sensitive and specific, routine MRE for NAFLD/NASH fibrosis screening can also be cost prohibitive. Fibroscan and SWE are more cost effective and are routinely performed via a transabdominal probe for liver fibrosis screening in patients with NAFLD/NASH, but their accuracy may be impeded in patients with obesity.

Endoscopic ultrasound (EUS) approaches to elastography may hold several technical advantages over transabdominal in patients with obesity due to EUS-SWE's ability to visualize the liver parenchyma under a thin sub-centimeter gastric or duodenal wall, unlike transabdominal approaches in which the quality may be impacted by a thick abdominal wall. The main disadvantage to EUS-SWE, however, is that it is a fairly novel technology with no established stiffness cutoffs for the various fibrosis grades, unlike VCTE of which fibrosis grade cutoffs are well studied and standardized for patients with NAFLD/ NASH.

Specific aims/hypotheses:

The investigators aim to determine the efficacy of EUS-SWE compared to other non-invasive scoring systems, such as the FIB-4 score and Fibroscan in patients with elevated body mass index for purposes of liver fibrosis screening. The investigators would subsequently establish optimal stiffness (kPa) cutoffs for liver fibrosis grading in reference to liver biopsies for EUS-SWE for this patient population, as no standard cutoffs currently exist. The investigators hypothesize that EUS-SWE will be more accurate than conventional non-invasive screening tools for liver fibrosis grading.

Study design:

The investigators are performing a cross-sectional study with prospectively collected data on patients with elevated body mass index and suspected NAFLD/NASH who are referred for upper endoscopy and EUS for any indication and liver biopsy either obtained during the same endoscopic session or available within 6 months of the endoscopy. Study participants are recruited from two sites, Brigham and Women's Hospital and Brigham and Women's Faulkner Hospital (same healthcare system and electronic medical record). Once identified and consented, patients undergo clinically indicated EUS followed by the shear wave elastography portion which in general takes 2-3 minutes and does not expose the patient to any additional anticipated risk other than minimally increased sedation time. The EUS-SWE device being used is a linear EUS endoscope with SWE features (Aloka Arietta 850, Olympus America, Center Valley, PA), an FDA-approved device. Patient demographics, laboratory findings, past medical history, elastography, and liver biopsy results are then collected prospectively and then entered into a patient registry. The patient registry results are placed in a secure cloud server maintained by the Mass General Brigham healthcare system with detailed procedures in place to maintain patient privacy.

Statistical Analysis:

Variables will be reported as mean ± standard deviation or median [range] if continuous and as proportions if categorical. As all comparisons will be paired, analyses between continuous variables will be performed using paired student's t-test and between categorical variables using McNemar's test. Accuracy will be measured by area under the curve (AUC) analysis. Optimal stiffness cutoffs will be performed based on calculations for Youden's index, along with thresholds with minimal sensitivity and specificity of 0.9. Statistical analysis will be performed using SAS 9.4 (Cary, NC).

Being tested
Endoscopic ultrasound shear wave elastography
Medical subject headings
Non-alcoholic Fatty Liver Disease, Obesity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Endoscopic ultrasound shear wave elastographyDevice

    To perform the portion of the endoscopic ultrasound exam using this device, the endoscopic ultrasound probe is placed onto the surface of the stomach with the probe facing the left liver. The probe then transmits shear waves that propagate through the tissue. The waves themselves are ultrasound waves and are harmless. This is repeated 10 times on a region of interest as guided by the endoscopic ultrasound probe. The device used in question is the linear EUS (Aloka Arietta 850, Olympus America, Center Valley, PA).

Study groups in NCT05728697
Study groupRoleWhat they receive
Patients with nonalcoholic fatty liver disease and elevated body mass indexPatients who have BMI >=25 and suspected nonalcoholic fatty liver disease based on imaging, laboratory workup, or clinical history. Patients are included in the study if they have been selected for routine clinical endoscopic ultrasound (can be for any indication) with liver biopsy either during the same session or within 6 months.
Receives: Device: Endoscopic ultrasound shear wave elastography

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Accuracy of EUS-SWE in reference to the gold standard liver biopsy

    Accuracy is measured by performing area under the receiver operator characteristic (AUROC) analysis for different threshold of liver fibrosis (e.g. advanced fibrosis, cirrhosis). The AUROC c-statistic number will then be statistically compared to other non-invasive modalities, such as FIB-4 and Fibroscan who will have similar AUROC curves generated as surrogate for accuracy.

    Measured: Up to 6 months

  2. Optimal stiffness cutoffs for EUS-SWE based on AUROC analysis

    Optimal cutoffs can be derived with the Youden index in attempt to maximize sensitivity and specificity

    Measured: Up to 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Feb 2023
  2. Study start1 Jun 2021
  3. Primary completionOct 2026 (estimated)
  4. Study completionJan 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Cross-sectional
Enrolment
150 participants (estimated)
Target duration
1 Week
IDs, dates and publications
ClinicalTrials.gov ID
NCT05728697
Sponsor's protocol ID
2019P002007
Status last verified
Feb 2026
First submitted
18 Jan 2023
Last updated
2 Mar 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Sumida Y, Nakajima A, Itoh Y. Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. World J Gastroenterol. 2014 Jan 14;20(2):475-85. doi: 10.3748/wjg.v20.i2.475.

    PubMed 24574716
  • Xiao G, Zhu S, Xiao X, Yan L, Yang J, Wu G. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Hepatology. 2017 Nov;66(5):1486-1501. doi: 10.1002/hep.29302. Epub 2017 Sep 26.

    PubMed 28586172
  • Eilenberg M, Munda P, Stift J, Langer FB, Prager G, Trauner M, Staufer K. Accuracy of non-invasive liver stiffness measurement and steatosis quantification in patients with severe and morbid obesity. Hepatobiliary Surg Nutr. 2021 Oct;10(5):610-622. doi: 10.21037/hbsn-20-787.

    PubMed 34760965
  • Myers RP, Pomier-Layrargues G, Kirsch R, Pollett A, Duarte-Rojo A, Wong D, Beaton M, Levstik M, Crotty P, Elkashab M. Feasibility and diagnostic performance of the FibroScan XL probe for liver stiffness measurement in overweight and obese patients. Hepatology. 2012 Jan;55(1):199-208. doi: 10.1002/hep.24624. Epub 2011 Nov 18.

    PubMed 21898479
  • Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J. 2005 Aug;47(4):458-72. doi: 10.1002/bimj.200410135.

    PubMed 16161804
  • Termite F, Borrelli de Andreis F, Liguori A, Gasbarrini A, Attili F, Spada C, Miele L. The Role of Endoscopic Ultrasound in Assessing Portal Hypertension: A State-of-the-Art Literature Review and Evolving Perspectives. Liver Int. 2025 Apr;45(4):e16176. doi: 10.1111/liv.16176. Epub 2024 Nov 27.

    PubMed 39601324
  • Wang TJ, Jirapinyo P, Shah R, Schuster K, Papke DJ, Thompson CC, Doyon L, Lautz DB, Ryou M. EUS-guided shear wave elastography for fibrosis screening in patients with obesity and metabolic dysfunction-associated steatotic liver disease: a pilot study (with video). Gastrointest Endosc. 2025 Feb;101(2):456-462.e1. doi: 10.1016/j.gie.2024.10.054. Epub 2024 Oct 29.

    PubMed 39481576

Questions about this trial

What is this clinical trial studying?

An observational study of Non-Alcoholic Fatty Liver Disease and Non-alcoholic Steatohepatitis, run by Brigham and Women's Hospital at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 2 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Peter Konyn, MD (6177325500, pkonyn@bwh.harvard.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Accuracy of EUS-SWE in reference to the gold standard liver biopsy (time frame: Up to 6 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05728697, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Mar 2026.

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