Transient elastography (TE) has been introduced as a new, simple and noninvasive imaging technique for determining the degree of fibrosis in patients with chronic liver diseases, mainly chronic hepatitis C [50] . Corpechot et al. [51] compared liver stiffness as determined by TE (Fibroscan R ) to histological findings obtained by liver biopsy in 101 patients with PBC (n = 73) or primary sclerosing cholangitis (PSC; n = 28) and showed a highly significant correlation of liver stiffness with both degree of fibrosis and histological stage. Further studies in independent cohorts of PBC patients are warranted before TE can be regarded as an established alternative to liver biopsy in the staging of chronic cholestatic liver disease. Still, TE appears attractive as a screening tool in future therapeutic trials, as it may help overcome the limited staging accuracy of liver biopsy due to heterogeneous distribution of inflammation and fibrosis in PBC.