First-line assessment of patients with chronic liver disease with non-invasive techniques and without recourse to liver biopsy

It was initially an error that led me to develop non-invasive biomarkers of liver diseases [1]. After perforating the gallbladder of a friend in 1990, I wished that one day the assessment of patients with chronic liver disease could be carried out rapidly with noninvasive techniques and without the use of a liver biopsy. My first biomarker had no industrial development [2] but the others thereafter had professional developments, such as FibroTest with 500,000 tests prescribed worldwide in the last 7 years [3]. Twenty years later, it seems that there is little controversy concerning the utility of the most validated biomarkers versus biopsy [4–6]. Over the last 7 years, the opinions of more than 50 leaders from Nid Afdhal [7] to Vlad Ratziu [8] have been published on these biomarkers. From the evidence-based data, I will summarize my understanding of the main points of agreement and disagreement in 2010 and the main priorities for the years ahead.