{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T02:37:07Z","timestamp":1790563027042,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,9,10]],"date-time":"2017-09-10T00:00:00Z","timestamp":1505001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100005847","name":"Health and Medical Research Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005847","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005407","name":"Food and Health Bureau","doi-asserted-by":"publisher","award":["12131201"],"award-info":[{"award-number":["12131201"]}],"id":[{"id":"10.13039\/501100005407","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Variceal bleeding is a common and life\u2010threatening complication in patients with cirrhosis. Screening with upper endoscopy is recommended but is uncomfortable to patients. Non\u2010invasive assessment with transient elastography for liver\/spleen stiffness measurement (<jats:styled-content style=\"fixed-case\">LSM<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">SSM<\/jats:styled-content>) is accurate in detecting varices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To test the hypothesis that a new screening strategy for varices guided by <jats:styled-content style=\"fixed-case\">LSM<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">SSM<\/jats:styled-content> results (<jats:styled-content style=\"fixed-case\">LSSM<\/jats:styled-content>\u2010guided) is non\u2010inferior to universal endoscopic screening in detecting clinically significant varices in patients with cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a non\u2010inferiority, open\u2010label, randomized controlled trial. Adult patients with known chronic liver diseases, radiological evidence of cirrhosis and compensated liver function. The primary outcome was clinically significant varix diagnosed with upper endoscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between October 2013 and June 2016, 548 patients were randomized to <jats:styled-content style=\"fixed-case\">LSSM<\/jats:styled-content> arm (n\u00a0=\u00a0274) and conventional arm (n\u00a0=\u00a0274) which formed the intention\u2010to\u2010test (<jats:styled-content style=\"fixed-case\">ITT<\/jats:styled-content>) population. Patients in both study arms were predominantly middle\u2010aged men with viral hepatitis\u2010related cirrhosis in 85% of the cases. In the <jats:styled-content style=\"fixed-case\">ITT<\/jats:styled-content> analysis, 11\/274 participants in the <jats:styled-content style=\"fixed-case\">LSSM<\/jats:styled-content> arm (4.0%) and 16\/274 in the conventional arm (5.8%) were found to have clinically significant varices. The difference between two groups was \u22121.8% (90% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, \u22124.9% to \u22121.2%, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>.001). The absolute difference in the number of patients with clinically significant varices detected was 5\/16 (31.3%) fewer in the <jats:styled-content style=\"fixed-case\">LSSM<\/jats:styled-content> arm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Non\u2010inferiority of the <jats:styled-content style=\"fixed-case\">LSSM<\/jats:styled-content>\u2010guided screening strategy to the convention approach cannot be excluded by this <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>. This approach should be further evaluated in a cohort of larger sample size with more clinically significant varices.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13560","type":"journal-article","created":{"date-parts":[[2017,8,29]],"date-time":"2017-08-29T18:16:43Z","timestamp":1504030603000},"page":"636-644","source":"Crossref","is-referenced-by-count":40,"title":["A new screening strategy for varices by liver and spleen stiffness measurement (<scp>LSSM<\/scp>) in cirrhotic patients: A\u00a0randomized trial"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2863-9389","authenticated-orcid":false,"given":"Grace L. H.","family":"Wong","sequence":"first","affiliation":[{"name":"Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"State Key Laboratory of Digestive Disease The Chinese University of Hong Kong  Hong Kong 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  Hong Kong Hong Kong"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aric J.","family":"Hui","sequence":"additional","affiliation":[{"name":"Alice Ho Miu Ling Nethersole Hospital  Hong Kong 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  Hong Kong Hong Kong"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai\u2010Tin","family":"Ho","sequence":"additional","affiliation":[{"name":"Alice Ho Miu Ling Nethersole Hospital  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeline O. S.","family":"Lo","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"State Key Laboratory of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin L. Y.","family":"Lam","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"State Key Laboratory of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heyson C. H.","family":"Chan","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"State Key Laboratory of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashid A.","family":"Lui","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"State Key Laboratory of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth H. D.","family":"Au","sequence":"additional","affiliation":[{"name":"Alice Ho Miu Ling Nethersole Hospital  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry L. Y.","family":"Chan","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"State Key Laboratory of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent W. S.","family":"Wong","sequence":"additional","affiliation":[{"name":"Institute of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"Department of Medicine and Therapeutics The Chinese University of Hong Kong  Hong Kong Hong Kong"},{"name":"State Key Laboratory of Digestive Disease The Chinese University of Hong Kong  Hong Kong Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60692-4"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001921"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60121-5"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2015.1021905"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2010.06.004"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2007.08.041"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.1870210502"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v5.i5.264"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/gastro\/got007"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2008.157735"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21665"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2008.08.018"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2006.04.006"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.05.035"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.119"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-2980.12359"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2012.11.019"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2013.51"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.2001.01397-3.x"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.05.022"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.06.036"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.06.006"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.06.027"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2013.09.029"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61425-1"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.02.058"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.80"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23312"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2893.2008.01037.x"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fliv.13560","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.13560","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T17:00:13Z","timestamp":1695574813000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.13560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,10]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1111\/liv.13560"],"URL":"https:\/\/doi.org\/10.1111\/liv.13560","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,10]]}}}