ArticleAlimentary pharmacology & therapeutics2025
Cholate Shunt, Oral Cholate Challenge and Endoscopic Lesions of Portal Hypertension: The SHUNT-V Study.
Article in Alimentary pharmacology & therapeutics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03583996 (The HepQuant SHUNT Liver Diagnostic Kit for Likelihood of Large Esophageal Varices), which is not on this map. Cited by 7 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The HepQuant SHUNT Liver Diagnostic Kit for Likelihood of Large Esophageal Varices: The SHUNT-V Study
Who cites it
7 citing papers in PubMed.
- Hepatic cholate clearance as assessed by HepQuant-SHUNT is associated with clinical outcomes in individuals with Fontan circulation.International journal of cardiology. Congenital heart disease · 2026Article
- Beyond Liver Function Tests, Liver Stiffness, and Portal Pressure: Portal-Systemic Shunting as a New Endpoint for Clinical Trials of Cirrhosis and Portal Hypertension.Gastro hep advances · 2026Article
- Cholate Clearance: Improving the Assessment of Liver Health Compared to Current Liver Tests.Gastro hep advances · 2026Article
- Evidence Supporting Utility of the Oral Cholate Challenge Test of Liver Function and Physiology to Aid Clinical Management: A Review of Analytical and Clinical Validation Studies.Gastro hep advances · 2026Review
- When should I repeat the endoscopy in my patient with compensated cirrhosis, whom I just scoped and who had no or small varices?Translational gastroenterology and hepatology · 2026Article
- Future of Endoscopy in Surveillance of Esophageal Varices.Current gastroenterology reports · 2025Review
- The Cholate Challenge Test Quantified Baseline Functional Heterogeneity and Improvement in Response to Resmetirom in MASH-related Child-Pugh A Cirrhosis.Gastro hep advances · 2025Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundThe 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.
aimsIn the US multicentre SHUNT-V study, we evaluated the disease severity index (DSI) for detecting LEV and other lesions of PH at endoscopy.
methodsSubjects 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 ≤ 18.3 was evaluated as a cut-off for ruling out LEV with acceptance criteria of negative likelihood ratio < 0.52 and sensitivity > 85%.
resultsSHUNT-V enrolled 306 subjects; 275 had both DSI and endoscopy, and 238 had Child-Pugh 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%-100% for LEV and 97.3%-100% for all significant PH lesions. If DSI ≤ 18.3 were used as the sole determinant to defer EGD, 27%-35% of EGDs could have been avoided with 0%-3.7% of LEV and 0%-2.7% of all significant PH lesions missed.
conclusionsHepQuant 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-systemic shunting, can aid in the decision to defer endoscopy for varices in patients with Child-Pugh A cirrhosis.
trial registrationThe SHUNT-V study was registered at ClinicalTrials.gov (NCT03583996).
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