{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:13:55Z","timestamp":1783430035199,"version":"3.54.6"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"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":["Liver International"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Detecting gastroesophageal varices with a high risk of bleeding (HRV) in children with biliary atresia requires endoscopies from an early age to apply primary prophylaxis of bleeding. However, repeated endoscopies are invasive and costly. This study was performed to define tools to rule out HRV, with the objective of reducing the number of endoscopies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Children with biliary atresia and portal hypertension were prospectively enrolled. Laboratory tests, elastography, echocardiography, and endoscopy were performed. Variables were subjected to principal component analysis, followed by multivariate logistic regression analyses for HRV prediction. The effectiveness of composite models and criteria based on liver and spleen stiffness measurements was evaluated using the missed HRV ratio and the spared endoscopy rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 100 children enrolled, a higher indexed right atrium area, higher left ventricle end\u2010diastolic diameter, younger age, higher serum bile acid concentration, and higher spleen stiffness were independently associated with HRV. In children under 3\u2009years old, a model combining indexed right atrium area from echocardiography and serum bile acid concentration achieved a 37% spared endoscopy rate with no missed HRV. For children over 3\u2009years old, spleen stiffness of \u2264\u200930\u2009kPa was associated with a 41% spared endoscopy rate and no missed HRV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Combining an echocardiography\u2010based model for children under 3\u2009years old with spleen stiffness criteria for older children may reduce the need for screening endoscopies by 40% in children with biliary atresia and portal hypertension.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70596","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T06:25:55Z","timestamp":1775283955000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Echocardiography, Bile Acids and Spleen Stiffness to Rule Out High\u2010Risk Varices in Children With Biliary Atresia"],"prefix":"10.1111","volume":"46","author":[{"given":"Virginie","family":"Lambert","sequence":"first","affiliation":[{"name":"Cardiologie Cong\u00e9nitale Montsouris, Institut M\u00e9dico\u2010Chirurgical Montsouris  Paris France"},{"name":"Radiologie Diagnostique et Interventionnelle p\u00e9diatrique, H\u00f4pital Bic\u00eatre, Assistance Publique H\u00f4pitaux de Paris and Universit\u00e9 Paris\u2010Saclay  Le Kremlin\u2010Bic\u00eatre France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Paul","family":"Teglas","sequence":"additional","affiliation":[{"name":"Centre de Recherche en \u00c9pid\u00e9miologie et Sant\u00e9 Des Populations, Inserm U1018 and Universit\u00e9 Paris\u2010Saclay  Le Kremlin\u2010Bic\u00eatre France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oanez","family":"Ackermann","sequence":"additional","affiliation":[{"name":"H\u00e9patologie et Transplantation h\u00e9patique p\u00e9diatriques, Centre de r\u00e9f\u00e9rence de L'atr\u00e9sie Des Voies Biliaires et Des Cholestases g\u00e9n\u00e9tiques, FSMR FILFOIE, ERN RARE LIVER, H\u00f4pital Bic\u00eatre, Assistance Publique H\u00f4pitaux de Paris  Le Kremlin\u2010Bic\u00eatre France"},{"name":"INSERM U1193, Hepatinov, Universit\u00e9 Paris\u2010Saclay  Orsay France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie","family":"Franchi\u2010Abella","sequence":"additional","affiliation":[{"name":"Radiologie Diagnostique et Interventionnelle p\u00e9diatrique, H\u00f4pital Bic\u00eatre, Assistance Publique H\u00f4pitaux de Paris and Universit\u00e9 Paris\u2010Saclay  Le Kremlin\u2010Bic\u00eatre France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Tiret","sequence":"additional","affiliation":[{"name":"H\u00e9patologie et Transplantation h\u00e9patique p\u00e9diatriques, Centre de r\u00e9f\u00e9rence de L'atr\u00e9sie Des Voies Biliaires et Des Cholestases g\u00e9n\u00e9tiques, FSMR FILFOIE, ERN RARE LIVER, H\u00f4pital Bic\u00eatre, Assistance Publique H\u00f4pitaux de Paris  Le Kremlin\u2010Bic\u00eatre France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0557-5180","authenticated-orcid":false,"given":"Rapha\u00ebl","family":"Veil","sequence":"additional","affiliation":[{"name":"Service de Sant\u00e9 Publique et d'Epid\u00e9miologie, H\u00f4pital Bic\u00eatre, Assistance Publique H\u00f4pitaux de Paris and Universit\u00e9 Paris\u2010Saclay  Le Kremlin Bic\u00eatre France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Bernard","sequence":"additional","affiliation":[{"name":"H\u00e9patologie et Transplantation h\u00e9patique p\u00e9diatriques, Centre de r\u00e9f\u00e9rence de L'atr\u00e9sie Des Voies Biliaires et Des Cholestases g\u00e9n\u00e9tiques, FSMR FILFOIE, ERN RARE LIVER, H\u00f4pital Bic\u00eatre, Assistance Publique H\u00f4pitaux de Paris  Le 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