About Toronto Liver Centre

About Dr. Magdy Elkhashab

 

Dr. Magdy Elkhashab graduated from Cairo University in 1981. He went on to do postgraduate training in Internal Medicine, and then immigrated to Canada.  He did three years of research and completed Master’s Degree in Immunology at the University of Western Ontario.  He then joined the University of Toronto and completed four years of residency in Internal Medicine followed by two years of Gastroenterology Fellowship.  He then completed two-year Fellowship in Hepatology.  He worked at the Liver Study Unit at Toronto Mount Sinai Hospital for seven years. He then opened his own practice at the Toronto Liver Centre in 1998.

 

His main interests are clinical medicine, teaching, and clinical research. He is currently an active staff at North York General Hospital and the Director of the Toronto Liver Center. He is an Adjunct Lecturer at the University of Toronto.

 

Dr. Elkhashab was the first in Canada to established the FibroScan Program, which now serves patients in 8 locations around the GTA. Fibroscan is a novel non-invasive technology that has been gaining popularity for the evaluation of hepatic fibrosis in patients with chronic liver disease of different etiologies. It measures the degree of liver stiffness. The technology utilizes ultrasonic waves hence there is no radiation exposure.  Fibroscan is a very useful tool for diagnosis of early cirrhosis. Confirmatory long term longitudinal studies are being done to confirm the validity of Fibroscan in monitoring of disease progression, screening for complications of cirrhosis such as esophageal varices and hepatocellular carcinoma and also screening for portal hypertension.

 

It has also been shown that transient elastography is useful in the prediction of the stage of liver fibrosis in patients with alcoholic liver disease. Transient elastography would also be valuable for assessing the severity of recurrent hepatitis C after liver transplantation.

 

I am very pleased to be able to provide our patients with this relatively new and exciting technology.  I hope with this technology at hand we will be able to provide our patients with the best therapeutic decisions and outcomes.

 

 

Scientific Background

 

Non-invasive liver elastography (Fibroscan) for detection of cystic fibrosis-associated liver disease. Assessment of liver fibrosis and steatosis is now almost indispensable in most of the chronic liver diseases in order to determine prognosis and need for treatment, and to monitor disease progression and response to treatment.

 

Fibroscan measures liver stiffness in volume then approximates a cylinder 1 cm wide and 4 cm long, between 25 mm and 65 mm below the skin surface. This volume is at least 100 larger than a biopsy sample and is therefore far more representative of liver parenchyma.

 

The prognosis and management of chronic liver disease largely relies on the extent and progression of hepatic fibrosis.  For instance, in patients with chronic hepatitis C precise staging of liver fibrosis is essential as fibrosis is the most important predictor of disease outcome. In addition fibrosis stage influences the indication for antiviral therapy. To date, liver biopsy traditionally has been considered the gold standard for evaluating hepatic fibrosis. As you all know, a liver biopsy has limitations including being an invasive and painful procedure. In addition, it has a poor patient acceptance and carries a small risk of life-threatening complications.

 

One of the most important limitations for a liver biopsy is a sampling error and intra and inter observer variability that may lead to over or under estimation of liver fibrosis stage. Even in the best hands when an experienced physician performs a liver biopsy and an expert pathologist interprets the results, the error rate in disease stage may reach up to 20-30%. Finally, a liver biopsy is not the ideal procedure as a serial assessment of disease progression.