Forlano R, Castellaneta NM, Suppressa P. Letter to the Editor: Filling the gaps in non-invasive assessment of liver fibrosis in metabolic dysfunction-associated steatotic liver disease. World J Hepatol 2026; 18(8): 117777 [DOI: 10.4254/wjh.117777]
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Roberta Forlano, MD, PhD, Associate Professor, Gastroenterology Unit, General Regional Hospital “F Miulli”, Strada Provinciale Acquaviva-Santeramo, Acquaviva delle Fonti 70021, Puglia, Italy. forlano@lum.it
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Medicine, Research & Experimental
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letter
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Forlano R, Castellaneta NM, Suppressa P. Letter to the Editor: Filling the gaps in non-invasive assessment of liver fibrosis in metabolic dysfunction-associated steatotic liver disease. World J Hepatol 2026; 18(8): 117777 [DOI: 10.4254/wjh.117777]
World J Hepatol. Aug 27, 2026; 18(8): 117777 Published online Aug 27, 2026. doi: 10.4254/wjh.117777
Letter to the Editor: Filling the gaps in non-invasive assessment of liver fibrosis in metabolic dysfunction-associated steatotic liver disease
Roberta Forlano, Nicola Maurizio Castellaneta, Patrizia Suppressa
Roberta Forlano, Nicola Maurizio Castellaneta, Gastroenterology Unit, General Regional Hospital “F Miulli”, Acquaviva delle Fonti 70021, Puglia, Italy
Roberta Forlano, Patrizia Suppressa, Department of Medicine, LUM University, Casamassima 70010, Puglia, Italy
Patrizia Suppressa, Department of Internal Medicine, General Regional Hospital “F Miulli”, Acquaviva delle Fonti 70021, Puglia, Italy
Author contributions: Forlano R wrote the manuscript; Catellaneta NM and Suppreessa P reviewed the draft; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Roberta Forlano, MD, PhD, Associate Professor, Gastroenterology Unit, General Regional Hospital “F Miulli”, Strada Provinciale Acquaviva-Santeramo, Acquaviva delle Fonti 70021, Puglia, Italy. forlano@lum.it
Received: December 16, 2025 Revised: January 14, 2026 Accepted: February 2, 2026 Published online: August 27, 2026 Processing time: 245 Days and 20.4 Hours
Abstract
In this letter to the editor, we discuss the strengths and weaknesses of the paper from Joseph et al. We take to opportunity to review the clinical importance of screening metabolic dysfunction associated steatotic liver disease patients for significant fibrosis. The use of a first line blood test is crucial for cost and availability, although this may overestimate and underestimate in patients with normal liver enzymes. Liver stiffness as a second line test, decreases the number of false positives, although it may be influenced by operator experience, cost and patients’ body habitus. Future studies are required to explore the application of further technologies in the screening. Nevertheless, for the time being, a 2 tier-system still represents the best option to screen a large number of patients and to optimise resources.
Core Tip: Non-invasive assessment of liver fibrosis remains challenging in patients suffering from metabolic dysfunction associated steatotic liver disease. A two-tier system including blood tests and elastography still remains the most sensible and practical approach to address this unmet need.
