A two-step screening pathway using blood tests and imaging reduced wait times for liver specialists by more than half for patients with metabolic dysfunction-associated steatotic liver disease (MASLD), according to research presented at The Liver Meeting 2026 in Denver, GastroEndoNews reported.
Researchers at McGill University implemented a triage system that uses age-adjusted Fibrosis-4 (FIB-4) scores to identify low-risk patients, followed by transient elastography for those who need further evaluation. The approach cut the average time from referral to elastography from 13.2 months to 5.5 months and reduced the wait for hepatology consultation from 30.0 months to 13.2 months.
Blood Test First, Imaging Second
The pathway, presented by Giada Sebastiani, MD, a professor of medicine at McGill University in Montreal, uses age-adjusted FIB-4 cutoffs to stratify risk. Patients under 65 with scores below 1.3, and those 65 and older with scores below 2.0, are considered low risk and can remain in primary care. Those above the thresholds proceed to transient elastography.
Sebastiani and her co-investigators tested the model in a quasi-experimental study of 3,953 consecutive MASLD patients who underwent elastography between 2013 and 2025. Of these, 1,750 were referred before the pathway was introduced and 2,203 afterward. The mean age was 62 years, and 73% were male.
Specialists See the Right Patients Sooner
The reorganization shifted care away from unnecessary specialist visits. The share of patients who did not require an in-person hepatology visit increased from 45% to 80%, while the rate of missed hepatology appointments fell from 23% to 15%.
Detection of advanced fibrosis within 12 months of referral doubled from 10% to 20%, indicating that high-risk patients were identified and prioritized faster rather than being lost in the backlog.
“The two-step pathway allows us to identify patients who require specialist assessment while avoiding unnecessary hepatology consultations for those at low risk of advanced fibrosis,” Sebastiani said.
Primary Care Can Start Treatment Immediately
Patients remained under the care of their primary care providers while awaiting further assessment. Sebastiani emphasized that MASLD management should not be delayed while waiting for FibroScan or a hepatology consultation.
“Primary care providers can initiate lifestyle interventions, weight management, and optimization of cardiometabolic risk factors, including diabetes, obesity, dyslipidemia, and hypertension,” she said.
She urged clinicians to evaluate fibrosis risk in MASLD patients—especially those with type 2 diabetes or obesity—without waiting for elevated liver enzymes or a specialist referral.
What Remains Unknown About Long-Term Outcomes
While the pathway improved access and detection rates, the study did not report whether the faster identification of advanced fibrosis translated into reduced rates of cirrhosis, liver failure, or mortality over longer follow-up periods. Sebastiani reported no relevant financial disclosures.
How FIB-4 Scores Determine Triage Levels
What is MASLD?
Metabolic dysfunction-associated steatotic liver disease is a condition characterized by fat buildup in the liver linked to metabolic risk factors such as obesity, diabetes, and dyslipidemia. It is the focus of the triage pathway studied at The Liver Meeting 2026.
How does the FIB-4 score work in this pathway?
The first step uses age-adjusted FIB-4 cutoffs: a score below 1.3 for patients under 65, or below 2.0 for those 65 and older, classifies a patient as low risk and keeps them in primary care rather than referring them immediately to a specialist.
What happened to wait times after the pathway was implemented?
The mean time from referral to transient elastography fell from 13.2 months to 5.5 months, a 58% reduction, while the mean time from referral to hepatology consultation dropped from 30.0 months to 13.2 months, a 56% reduction.
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