{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T09:49:33Z","timestamp":1791625773622,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,10]],"date-time":"2024-11-10T00:00:00Z","timestamp":1731196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,11,10]],"date-time":"2024-11-10T00:00:00Z","timestamp":1731196800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The accuracy of current criteria for ruling out large oesophageal varices (LEV) and other endoscopic lesions of portal hypertension (PH) may be compromised by obesity and MASLD\/MASH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In the US multicentre SHUNT\u2010V study, we evaluated the disease severity index (DSI) for detecting LEV and other lesions of PH at endoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Subjects were adults with compensated cirrhosis scheduled for endoscopy to screen for varices. DSI was calculated from clearances of labelled cholates after oral and intravenous administration. DSI\u2009\u2264\u200918.3 was evaluated as a cut\u2010off for ruling out LEV with acceptance criteria of negative likelihood ratio\u2009&lt;\u20090.52 and sensitivity\u2009&gt;\u200985%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SHUNT\u2010V enrolled 306 subjects; 275 had both DSI and endoscopy, and 238 had Child\u2013Pugh A cirrhosis (52.1% MASLD\/MASH, 25.2% chronic hepatitis C and 15.6% alcoholic liver disease; 87% were overweight, 64% were obese and 54% had diabetes). AUROCs for DSI ranged from 0.81 to 0.82 for LEV and 0.79 to 0.80 for all significant PH lesions. DSI 18.3 had sensitivity 96.3%\u2013100% for LEV and 97.3%\u2013100% for all significant PH lesions. If DSI\u2009\u2264\u200918.3 were used as the sole determinant to defer EGD, 27%\u201335% of EGDs could have been avoided with 0%\u20133.7% of LEV and 0%\u20132.7% of all significant PH lesions missed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HepQuant DSI predicts the likelihood of LEV and significant PH lesions across a spectrum of patient characteristics and disease aetiologies. DSI, based on liver function and portal\u2010systemic shunting, can aid in the decision to defer endoscopy for varices in patients with Child\u2013Pugh A cirrhosis.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      The SHUNT\u2010V study was registered at\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      (NCT03583996)\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.18386","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T02:13:43Z","timestamp":1731291223000},"page":"75-87","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cholate Shunt, Oral Cholate Challenge and Endoscopic Lesions of Portal Hypertension: The\n                    <scp>SHUNT<\/scp>\n                    \u2010V Study"],"prefix":"10.1111","volume":"61","author":[{"given":"Mitchell","family":"Shiffman","sequence":"first","affiliation":[{"name":"Bon Secours Liver Institute of Virginia  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Rajender","family":"Reddy","sequence":"additional","affiliation":[{"name":"University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Leise","sequence":"additional","affiliation":[{"name":"Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamran","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alastair D.","family":"Smith","sequence":"additional","affiliation":[{"name":"Syneos Health  Morrisville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Helmke","sequence":"additional","affiliation":[{"name":"HepQuant, LLC  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kittelson","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz Medical Center  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2126-9442","authenticated-orcid":false,"given":"Michael P.","family":"McRae","sequence":"additional","affiliation":[{"name":"Custom DX Solutions LLC  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne C.","family":"Imperial","sequence":"additional","affiliation":[{"name":"Consultant to HepQuant, LLC  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0454-3566","authenticated-orcid":false,"given":"Gregory T.","family":"Everson","sequence":"additional","affiliation":[{"name":"HepQuant, LLC  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SHUNT\u2010V Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,10]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21907"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2013.07.023"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.04.006"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.05.025"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.018"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072\u2010008\u20109096\u20108"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13318"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2019.01028"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.04.062"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.05.022"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.022"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0000000000000167"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102036.2007.03389.x"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102036.2008.03639.x"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.24752"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16283"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.500030210"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016\u20105085(13)63537\u20104"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trsl.2020.12.010"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32188"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016\u20105085(22)63507\u20108"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/cts.13786"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcpt.13980"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.18054"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trsl.2022.08.002"},{"key":"e_1_2_11_28_1","volume-title":"Applied Logistic Regression","author":"Hosmer D. 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