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This study aimed to determine changes in endoscopist-driven sedation practices 5 years after the first nationwide survey in 2014 by the Korean Society of Gastrointestinal Endoscopy (KSGE).A 59-item survey covering current practices was electronically mailed to all members of the KSGE in 2019.In total, 955 (12.8%) out of 7,486 questionnaires were returned. A total of 738 (77.7%) out of 955 respondents attended dedicated sedation education programs. The American Society of Anesthesiologists class was recorded by 464 (51.2%) out of 907 respondents. The recording rate was higher in respondents who completed sedation education (p=0.014) and worked in general or tertiary hospitals (p0.001). Compared to that reported in the previous survey, the reported use of propofol was higher in 2019. The respondents had higher satisfaction scores for propofol-based sedation compared with midazolam monotherapy (p0.001). The rates of oxygen supplementation (p0.001) and oxygen saturation level monitoring (p0.001) during sedative endoscopy were higher in 2019 than in the previous survey. A total of 876 (98.4%) out of 890 respondents reported a separate recovery bay, and 615 (70.5%) out of 872 respondents reported that personnel were assigned solely to the recovery bay.Endoscopist-driven sedation and monitoring practices in 2019 were significantly different than those in 2014. The respondents favored propofol-based sedation and utilized oxygen supplementation and monitoring of O

OBJECTIVES Some neoplastic lesions remain undetected on colonoscopy. To date, no studies have investigated whether combining cap-assisted colonoscopy with chromoendoscopy increases the adenoma detection rate (ADR). This study aimed to compare cap-assisted chromoendoscopy (CAP/CHROMO) with standard colonoscopy (SC) with respect to their efficacy in detecting adenomas. METHODS This prospective, multicenter, randomized controlled trial included asymptomatic subjects aged 45-75 years who underwent colonoscopy for the first time at 14 university hospitals. Subjects were randomized to either the CAP/CHROMO group (with 0.09% indigo carmine spraying using a cap-mounted catheter at the tip of the colonoscope) or the SC group. All polyps were resected, but only histologically confirmed neoplastic lesions were considered for analysis. The primary outcome was ADR, defined as the proportion of subjects with at least 1 adenoma. RESULTS A total of 1,905 subjects were randomized to the CAP/CHROMO (n = 948) or SC (n = 957) group at 14 centers. Subjects' demographic characteristics were similar between both groups. The CAP/CHROMO group had significantly higher ADR than the SC group (54.4% vs 44.9%, P < 0.001). Significantly, more subjects with at least 1 proximal colon adenoma were identified by CAP/CHROMO (38.6%) than by SC (31.2%) (P = 0.001). The proximal serrated polyp detection rate by CAP/CHROMO was significantly higher in the female subgroup vs SC. However, advanced ADR was not different between the CAP/CHROMO and SC groups (9.3% vs 7.6%, P = 0.180). DISCUSSION CAP/CHROMO markedly improved the ADR and enhanced the detection of proximal adenoma. CAP/CHROMO is feasible for routine application and will allow for a more effective surveillance program.

Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Cardiopulmonary complications are usually temporary. Most patients recover without sequelae. However, they may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk.

Background/aims Inflammatory bowel disease (IBD) is associated with the occurrence of venous thromboembolism (VTE). However, to date, there have been few studies on the risk of VTE in Asian IBD patients. We aimed to estimate the incidence of VTE in Asian IBD patients and to determine if IBD is related to increased VTE risk. Methods We performed a population-based cohort study between 2004 and 2015 using Korean National Health Insurance data. IBD and VTE were defined by ICD-10 codes. Incidence rates of VTE were calculated among patients with IBD and among age- and sex-matched controls. Hazard ratios were estimated using Cox regression with adjustment for multiple variables. We performed additional analyses stratifying by age, sex, Charlson comorbidity index (CCI) score, and disease type. Results Among the 45,037 patients with IBD (IBD cohort) and 133,019 matched controls (non-IBD cohort) included in our analysis, 411 IBD patients and 641 controls developed VTE. The IBD cohort had a higher incidence rate ratio and risk of VTE than the non-IBD cohort (incidence rate ratio: 1.92 and hazard ratio: 1.93). Older age, female sex, higher CCI scores, cardiovascular disease, chronic kidney disease, use of steroids, and hospitalization were significant risk factors for VTE in patients with IBD. Conclusions The IBD patients in this study were approximately two times more likely to develop VTE than the non-IBD individuals. Our findings support the need for thromboprophylaxis in Asian IBD patients with various factors that further increase the risk of VTE.

Background/Aims Regulatory dendritic cells (rDCs), which can be induced by mesenchymal stem cells (MSCs), play an important role in inducing and maintaining homeostasis of regulatory T cells and exhibit anti-inflammatory functions. In this study, we investigated whether MSCs could differentiate DCs into rDCs and compared the therapeutic effects of rDCs and MSCs on dextran sodium sulfate (DSS)-induced chronic colitis mice. Methods Immature DCs (imDCs) and lipopolysaccharide (LPS)-treated mature DCs (mDCs) were co-cultured with MSCs for 48 hours, and then the profiles of surface markers and cytokines and regulatory roles of these DCs for primary splenocytes were analyzed. In addition, the therapeutic effects of MSCs and DCs co-cultured with MSCs were compared in chronic colitis mice. Results After co-culture of imDCs (MSC-DCs) or LPS-treated mDCs (LPS+MSC-DCs) with MSCs, the expression of CD11c, CD80, CD86, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ), was decreased, but that of CD11b, IL-10, and transforming growth factor-β (TGF-β) was increased. Furthermore, MSC-DCs and LPS+MSC-DCs induced the expression of CD4, CD25, and Foxp3 in primary splenocytes isolated from mice. In DSS-induced colitis mice, MSCs and MSC-DCs increased colon length, body weight, and survival rate and induced histological improvement. Moreover, in the colon tissues, the expression of IL-6, TNF-α, and IFN-γ decreased, but that of IL-10, TGF-β, and Foxp3 increased in the MSC- and MSC-DC-injected groups. Conclusions Our data suggest that MSCs differentiate DCs into rDCs, which ameliorate chronic colitis. Thus, rDCs stimulated by MSCs may be therapeutically useful for the treatment of chronic inflammatory diseases.

Background/Aims We compared the cirrhosis-prediction accuracy of an ultrasonographic scoring system (USSS) combining six representative sonographic indices with that of liver stiffness measurement (LSM) by transient elastography, and prospectively investigated the correlation between the USSS score and LSM in predicting cirrhosis. Methods Two hundred and thirty patients with chronic liver diseases (187 men, 43 women; age, 50.4±9.5 y, mean±SD) were enrolled in this prospective study. The USSS produces a combined score for nodularity of the liver surface and edge, parenchyma echogenicity, presence of right-lobe atrophy, spleen size, splenic vein diameter, and abnormality of the hepatic vein waveform. The correlations of the USSS score and LSM with that of a pathological liver biopsy (METAVIR scoring system: F0-F4) were evaluated. Results The mean USSS score and LSM were 7.2 and 38.0 kPa, respectively, in patients with histologically overt cirrhosis (F4, P=0.017) and 4.3 and 22.1 kPa in patients with fibrotic change without overt cirrhosis (F0-F3) (P=0.025). The areas under the receiver operating characteristic (ROC) curves of the USSS score and LSM for F4 patients were 0.849 and 0.729, respectively. On the basis of ROC curves, criteria of USSS ≥6: LSM ≥17.4 had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 89.2%:77.6%, 69.4%:61.4%, 86.5%:83.7%, 74.6%:51.9% and 0.83:0.73, respectively, in predicting F4. Conclusions The results indicate that this USSS has comparable efficacy to LSM in the diagnosis of cirrhosis.

The measurement of the hepatic venous pressure gradient (HVPG) for the estimation of portal hypertension (PH) in cirrhosis has some limitations, including its invasiveness. Hepatic vein arrival time (HVAT), as assessed by microbubble contrast-enhanced ultrasonography (CEUS), is negatively correlated with the histological grade of liver fibrosis because of the associated hemodynamic abnormalities. Anatomical and pathophysiological changes in liver microcirculation are the initial events leading to PH. However, the direct relationship between HVAT and PH has not been evaluated. The present study measured both HVPG and HVAT in 71 consecutive patients with compensated cirrhosis and analyzed the relationship between the two parameters (i.e., the derivation set). Results were validated in 35 compensated patients with cirrhosis at another medical center (i.e., the validation set). The derivation set had HVPG and HVAT values of 11.4 ± 5.0 mmHg (mean ± standard deviation; range, 2-23) and 14.1 ± 3.4 seconds (range, 8.4-24.2), respectively; there was a statistically significant negative correlation between HVPG and HVAT (r(2) = 0.545; P < 0.001). The area under the receiver operating characteristic curve (AUROC) was 0.973 for clinically significant PH (CSPH; HVPG, ≥ 10 mmHg), and the sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios for CSPH for an HVAT cut-off value of 14 seconds were 92.7%, 86.7%, 90.5%, 89.7%, 6.95, and 0.08, respectively. In addition, a shorter HVAT was associated with worse Child-Pugh score (P < 0.001) and esophageal varices (P = 0.018). In the validation set, there was also a significant negative correlation between HVAT and HVPG (r(2) = 0.538; P < 0.001), and AUROC = 0.953 for CSPH. HVAT was significantly correlated with PH. These results indicate that measuring HVAT is useful for the noninvasive prediction of CSPH in patients with compensated cirrhosis.

The clinical impact and complications of hepatogenous diabetes (HD) on cirrhosis have not been elucidated. This study aimed to evaluate the relationship of HD with portal hypertension (PHT) and variceal hemorrhage and to assess the prevalence of HD. From July 2007 to December 2009, 75-g oral glucose tolerance test and insulin resistance (IR) were evaluated for 195 consecutive cirrhotic liver patients (M:F = 164:1, 53.0 ± 10.2 years) who had no history of diabetes mellitus. IR was calculated using the homeostasis model of assessment-insulin resistance (HOMA-IR) formula. Endoscopy for varices, hepatic venous pressure gradient (HVPG), and serologic tests were also conducted. HD was observed in 55.4 % (108/194) of the patients. Among them, 62.0 % required OGTT for diagnosis because they did not show an abnormal fasting plasma glucose level. The presence of HD showed a significant correlation with high Child–Pugh’s score, variceal hemorrhage, and HVPG (p = 0.004, 0.002, and 0.019, respectively). In multivariate analysis, Child–Pugh’s score (OR 1.43, 95 % CI 1.005–2.038) and HVPG (OR 1.15, 95 % CI 1.003–2.547) had significant relationships with HD. Patients with recent variceal hemorrhages (within 6 months) exhibited significantly higher glucose levels at 120 min in OGTT compared to patients without hemorrhages (p = 0.042). However, there was no difference in fasting glucose levels. The 120-min glucose level and HOMA-IR score were significantly and linearly correlated with HVPG (r 2 = 0.189, p

Background/Aims: This study sought to characterize the current sedation practices of Korean endoscopists in real- world settings. Methods: All active members of the Korean Society of Gastrointestinal Endoscopy were invited to com- plete an anonymous 35-item questionnaire. Results: The overall response rate was 22.7% (1,332/5,860). Propofol- based sedation was the dominant method used in both elec- tive esophagogastroduodenoscopy (55.6%) and colonoscopy (52.6%). The mean satisfaction score for propofol-based sedation was significantly higher than that for standard seda- tion in both examinations (all p

Background In experimental models, bone marrow-derived mesenchymal stem cells (BM-MSCs) have the capacity to differentiate into hepatocytes and exhibit antifibrotic effects. However, there have been no studies in humans with alcoholic cirrhosis. Aim The aim of this study was to elucidate the antifibrotic effect of BM-MSCs in patients with alcoholic cirrhosis, as a phase II clinical trial. Methods Twelve patients (11 males, 1 female) with baseline biopsy-proven alcoholic cirrhosis who had been alcohol free for at least 6 months were enrolled. BM-MSCs were isolated from each patient's BM and amplified for 1 month, and 5 × 107 cells were then injected twice, at weeks 4 and 8, through the hepatic artery. One patient was withdrawn because of ingestion of alcohol. Finally, 11 patients completed the follow-up biopsy and laboratory tests at 12 weeks after the second injection. The primary outcome was improvement in the patients’ histological features. Results According to the Laennec fibrosis system, histological improvement was observed in 6 of 11 patients (54.5%). The Child-Pugh score improved in ten patients (90.9%) and the levels of transforming growth factor-β1, type 1 collagen and α-smooth muscle actin significantly decreased (as assessed by real-time reverse transcriptase polymerase chain reaction) after BM-MSCs therapy (P

Summary Background/Aims The aim of this study was to investigate the relationship between microsatellite instability (MSI) and clinicopathologic features including multiplicity in early stage gastric neoplasias (ESGN). Methods From November 2004 until September 2009, 372 patients with consecutive resected gastric neoplasias were retrospectively enrolled. The gastric neoplasias were composed of 117 advanced gastric cancers (AGCs) and 255 ESGNs including 31 gastric dysplasias (including low and high grade dysplasia) and 224 early gastric cancers (EGCs). Results Based on microsatellite markers, high MSI (MSI-H) was observed in 61 cases (16.4%) and low MSI (MSI-L) in 14 cases (3.8%) of 372 cases. There was a positive correlation between the presence of MSI-H and progression of gastric adenoma to gastric tumor. We compared ESGNs with microsatellite stable (MSS; 223 cases, 87.5%) and ESGNs with MSI-H (24 cases, 9.4%). The ESGNs with MSI-H were only associated with older age and female gender. There were no association with Helicobacter pylori infection, intestinal metaplasia, and distal location in contrast with EGCs with MSI-H. Furthermore, multiplicity of ESGNs was not associated with MSI status. Conclusions The clinicopatholgic features of MSI-H phenotype were different according to the progression of gastric neoplasias from ESGNs to AGCs. ESGNs with MSI-H were only associated with old age, female sex. In addition ESGNs with MSI-H were not associated with an increased risk of multifocal tumors.

Although endoscopic submucosal dissection (ESD)-induced ulcers heal faster and recur less often than non-iatrogenic gastric ulcers, the optimal dosage and duration of proton pump inhibitor treatment for ESD-induced ulcers remain unclear.To evaluate the efficacy of half-dose rabeprazole on endoscopic submucosal dissection-induced ulcer compared with standard dose rabeprazole.The study was a prospective randomized controlled double-blind trial at a single tertiary hospital. A total of 80 patients who underwent ESD for gastric neoplasia were enrolled. Of these patients, 10 were not followed to completion. Final analysis included the remaining 70 patients. Rabeprazole 20 or 10 mg, depending on randomization, was given orally for 4 weeks after ESD.Of the 70 patients, 45 (64 %) were men, and the median age was 65.2 ± 9.7 years. The mean ESD-induced ulcer area was 673 mm(2). No significant differences in ulcer area reduction ratio (p = 0.49) or ulcer-related symptoms (p = 0.91) were observed between the two groups at 4 weeks after ESD.For ESD-induced ulcers, treatment with 10 mg of rabeprazole daily produces a similar outcome as 20 mg of rabeprazole with regard to healing efficacy and symptom resolution.

Further histological subclassification of cirrhosis may be useful because of heterogeneity of severity within cirrhosis. We aimed to determine the relationship between histological subclassification and clinical stage of cirrhosis as well as grade of portal hypertension.One hundred-twenty-three biopsy-proven cirrhosis patients, whose clinical stage of cirrhosis and hepatic venous pressure gradient (HVPG) could be estimated, were included in this prospective study. Histology of cirrhosis was blindly subclassified using the Laennec fibrosis scoring system semi-quantitatively without knowledge of the clinical stage or the HVPG results. The Laennec system subclassifies cirrhosis as mild - thin septa, moderate - at least two broad septa, and severe - at least one very broad septum or many minute nodules. Clinical stages were determined by the presence or absence of varices, ascites, and variceal hemorrhage. Biological and laboratory data were also collected.Alcohol intake was the most common cause of cirrhosis in this cohort (87, 70.7%). Histology of cirrhosis subclassified using the Laennec scoring system significantly correlated with both the clinical stage of cirrhosis (p0.001) and HVPG (mild: 8.1 ± 2.6 mm Hg, moderate: 12.4 ± 3.3mm Hg, severe: 16.3 ± 4.0 mm Hg, p0.001). With higher grades of histological subclassification of cirrhosis, increased frequency in both severe portal hypertension (HVPG ≥ 12 mm Hg) and episodes of variceal hemorrhage were observed (p0.001).Histological subclassification of cirrhosis by the Laennec fibrosis scoring system is tightly correlated with both the clinical stage of cirrhosis and grade of portal hypertension. This suggests that cirrhosis should be subclassified into different stages according to its histological severity.

Surveillance Strategy After Endoscopic Submucosal Dissection for Early Gastric Cancer: A Multicenter Study by Osaka University ESD Study Group Motohiko Kato, Tsutomu Nishida, Katsumi Yamamoto, Shinji Kitamura, Takeshi Nakamura, Akihiro Nishihara, Naoki Kawai, Shinichiro Zushi, Masato Komori, Kazuo Kinoshita, Tomoki Michida, Takuya Yamada, Shusaku Tsutsui, Masahiko Tsujii, Norio Hayashi Graduate School of Medicine, Department of Gastroenterology and Hepatology, Osaka University, Suita, Japan; Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan; Department of Gastroenterology, Sakai Municipal Hospital, Sakai, Japan; Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan; Department of Gastroenterology, Minoh City Hospital, Minoh, Japan; Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan; Department of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Japan; Department of Gastroenterology, Osaka Rosai Hospital, Sakai, Japan; Department of Gastroenterology, Sumitomo Hospital, Osaka, Japan; Endoscopy Center, Osaka Koseinenkin Hospital, Osaka, Japan Background and Aim: Endoscopic submucosal dissection (ESD) has been accepted as a treatment for early gastric cancer (EGC). However, it is known that the patient after endoscopic treatment of EGC is at risk of synchronous and metachronous multiple cancers, even though initial lesion is completely resected, and there is not enough evidence concerning surveillance strategy after ESD for EGC. The aim of this multicenter study is to clarify the surveillance strategy after ESD by assessing the incidence of multiple cancers during follow-up. Methods: This is a multicenter retrospective study from 6 institutes. From March 2003 to November 2010, of total 1567 consecutive cases with gastric neoplasm performed ESD at these 6 institute, 1041 cases were diagnosed as EGC after ESD and were included in this study. Cumulative incident rates of gastric cancer after initial ESD were calculated using the Kaplan-Meier methods. Results: In 1041 cases, multiple cancers were detected in 101 cases and incident rate was 9.7% in the median follow-up period of 28.3 months. The cumulative incident rates of gastric cancer were 7.4% at 1 year, 9.5% at 2 years, and 11.5% at 3 years, respectively. The cumulative incident rates curve showed an inflection point at 1.7 months, after that those increased constantly about 2% per year. Median and 90 percentile of duration between initial ESD and cancer incidence were 22.9 and 36.0 months, respectively. There were no significant differences in institute, patients’ background, and characteristics of initial lesion between cases with and without multiple cancers. All lesions detected during follow-up were successfully treated by re-ESD except 2 cases of mucosal cancers where ESD was not applicable because of undifferentiated histological type. Conclusion: These results suggested multiple cancers detected within 3 months after initial ESD for EGC were overlooked synchronous cancers in the pre-ESD survey. Metachronous lesions were detected with low but constant frequency during follow up. Our recommendation is that initial endoscopic surveillance should be performed within 3-6 months after ESD to check up synchronous lesions and scheduled endoscopic surveillance should be performed annually for at least 3 years. 1174 Randomized Controlled Trial of Conventional vs. Jumbo Forceps Biopsy for the Diagnostic Accuracy of Gastric Neoplasia Before Endoscopic Submucosal Dissection Hyun-Soo Kim, Hyo Keun Jeon, Jae Woo Kim, Hong Jun Park, so Yeon Park, Bo RA Kim, Chan Sik Won, Mee-Yon Cho Internal medicine, Yonsei Univ. Wonju College of Medicine, Wonju, Republic of Korea; Pathology, Yonsei Univ. Wonju College of Medicine, Wonju, Republic of Korea Aim: An endoscopic forceps biopsy carries the risk of missing the neoplastic foci within a gastric neoplastic lesion and underestimating the grade of neoplasia because only a small portion of the lesion is sampled using this technique. The aim of this prospective study was to compare the diagnostic accuracy of gastric neoplasia before endoscopic submucosal dissection (ESD) between conventional forceps and jumbo forceps. Patients and Methods: Between May 2009 and November 2010, 162 gastric neoplastic lesions (adenomas or early gastric cancers without ulcer) from 148 patients were randomized to two groups, conventional forceps (7 mm) and jumbo forceps (8 mm), and four specimens were obtained from each lesion. Each pathologic result of the four endoscopic biopsied specimens between the two groups was compared with that of ESD specimens. Results: Of the 148 patients, 123 (76.9%) were, men; median age was 64.66 10 years. Twenty-nine gastric neoplastic lesions in 26 patients were excluded because ESD was not performed or because pathologic result was inappropriate. Finally, 66 gastric neoplastic lesions in 60 patients and 65 gastric neoplastic lesions in 62 patients were allocated to conventional group and jumbo group. A total of 131 ESD specimens in 122 patients were analyzed. The pathological diagnoses of ESD specimens were as follows: 47 (35.9%) adenomas with low grade dysplasia, 20 (15.3%) adenomas with high grade dysplasia, and 63 (48.1%) adenocarcinomas. The mean diameter of the biopsy specimens were 2.48 0.53mm with conventional group, 2.89 0.60mm with jumbo group. Thus, significantly larger biopsy specimens were obtained by jumbo forceps than conventional forceps(p 0.001). The rates of concordance from the first to all four endoscopic forceps biopsy specimens and the ESD specimens were 66.7%, 72.7%, 74.2% and 80.3% in conventional forceps group and 72.3%, 76.9%, 81.5% and 84.6% in jumbo forceps group (p 0.483, p 0.580, p 0.315, p 0.517), respectively. The concordance rate was not associated with location of gastric neoplastic lesions or with experience of endoscopists (p 0.05). There were no variables found to be significantly associated with rates of concordance in multivariate analysis. Conclusions: Obtaining 4 endoscopic biopsy specimens rather than only one before ESD improved diagnostic accuracy by about 15%. Despite of bigger specimen size, however, jumbo forceps was not proven to be superior to the conventional forceps for better diagnostic accuracy of gastric neoplasia.

similar between the two groups, 22 days vs 30 days in patients without and with infection, respectively (p=ns). In conclusion, patients with HRS with bacterial infection have liver, renal, and circulatory dysfunction of similar intensity to that of patients with HRS without bacterial infection and a similarly low survival expectancy. These data suggest that vasoconstrictors and albumin should be evaluated for the management of patients with HRS and bacterial infection.

2. To assess whether the acute response to oral propranolol predicts the long-term response to these drugs. Methods: Thirty-eight patients with cirrhosis and HVPG ≥12mmHg were included. The HVPG was measured at baseline and 90 minutes after an oral dose of 80mg propranolol. Following randomisation, 17 patients received propranolol (mean dose 122.4mg/day) and 21 carvedilol (mean dose 14.0mg/day) titrated according to pulse and blood pressure response. After 12 weeks, HVPG-measurements were repeated. Results: Acute HVPG-response to propranolol was significant −19.3±12.8% (p < 0.01). Long-term treatment with propranolol and carvedilol decreased HVPG −12.5±16.7% (p < 0.01) and −18.7±16.7% (p < 0.01), respectively, with no significant difference between the two treatment-regimens (p = 0.26). The frequency of long-term responders (HVPG decrease ≥20% or to