{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:59:59Z","timestamp":1792036799249,"version":"4.4.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2019,3,15]],"date-time":"2019-03-15T00:00:00Z","timestamp":1552608000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,3,15]],"date-time":"2019-03-15T00:00:00Z","timestamp":1552608000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:p>We previously demonstrated the possible noninferiority of a screening strategy for varices guided by liver and spleen stiffness measurement (LSSM) compared to universal endoscopic screening in detecting clinically significant varices in patients with cirrhosis. We now report the long\u2010term outcome of the patients recruited in this trial for incident variceal bleeding and other hepatic events. This was a prospective follow\u2010up study of a noninferiority, open\u2010label, randomized controlled trial (NCT02024347) of 548 adult patients with known chronic liver diseases, radiological evidence of liver cirrhosis, and compensated liver function. The primary outcome of this prospective study was incident variceal bleeding confirmed with upper endoscopy. Between October 2013 and June 2016, 548 patients were randomized to an LSSM arm (n = 274) and a conventional arm (n = 274). Patients in both study arms were predominantly middle\u2010aged men (mean age 59 years, male 68.9%) with viral hepatitis\u2013related cirrhosis (85%). Upper endoscopy examination was performed in 127 (46.4%) patients in the LSSM arm and 263 (96.0%) in the conventional arm. During the follow\u2010up period of 41.3 \u00b1 12.6 months, 12\/274 patients in the LSSM arm (4.4%) and 11\/274 in the conventional arm (4.0%) developed incident variceal bleeding (log\u2010rank test <jats:italic toggle=\"yes\">P = <\/jats:italic>0.724). The incident rates of hepatic events were also similar in both arms (<jats:italic toggle=\"yes\">P = <\/jats:italic>0.327). <jats:italic toggle=\"yes\">Conclusions:<\/jats:italic> Patients with liver cirrhosis who had undergone LSSM\u2010guided variceal screening were at similarly low risk of incident variceal bleeding in the future; patients with cirrhosis may first have LSSM measured to save up to half of the upper endoscopy examinations.<\/jats:p>","DOI":"10.1002\/hep.30522","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T16:10:56Z","timestamp":1548432656000},"page":"971-981","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":43,"title":["Low Risk of Variceal Bleeding in Patients With Cirrhosis After Variceal Screening Stratified by Liver\/Spleen Stiffness"],"prefix":"10.1097","volume":"70","author":[{"given":"Grace Lai\u2010Hung","family":"Wong","sequence":"first","affiliation":[{"name":"Institute of Digestive Disease,The Chinese University of Hong Kong,Shatin,Hong Kong"},{"name":"Department of Medicine and Therapeutics,The Chinese University of Hong Kong,Shatin,Hong Kong"},{"name":"State Key Laboratory of Digestive Disease,The Chinese University of Hong Kong,Shatin,Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian Yan","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics,The Chinese University of Hong Kong,Shatin,Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Kwok","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease,The Chinese University of Hong Kong,Shatin,Hong Kong"},{"name":"Department of Medicine and Therapeutics,The Chinese University of Hong Kong,Shatin,Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aric Josun","family":"Hui","sequence":"additional","affiliation":[{"name":"Alice Ho Miu Ling Nethersole Hospital,Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yee\u2010Kit","family":"Tse","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease,The Chinese University of Hong Kong,Shatin,Hong Kong"},{"name":"Department of Medicine and Therapeutics,The Chinese University of Hong Kong,Shatin,Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry Lik\u2010Yuen","family":"Chan","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease,The Chinese University of Hong Kong,Shatin,Hong Kong"},{"name":"Department of Medicine and Therapeutics,The Chinese University of Hong Kong,Shatin,Hong Kong"},{"name":"State Key Laboratory of Digestive Disease,The Chinese University of Hong Kong,Shatin,Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent Wai\u2010Sun","family":"Wong","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease,The Chinese University of Hong Kong,Shatin,Hong Kong"},{"name":"Department of Medicine and Therapeutics,The Chinese University of Hong Kong,Shatin,Hong Kong"},{"name":"State Key Laboratory of Digestive Disease,The Chinese University of Hong Kong,Shatin,Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,3,15]]},"reference":[{"key":"hep30522-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1185\/03007995.2015.1021905","article-title":"Presentation and complications associated with cirrhosis of the liver","volume":"31","year":"2015","journal-title":"Curr Med Res Opin"},{"key":"hep30522-bib-0002-20241017","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1002\/hep.26301","article-title":"Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients with 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