Safety of Discontinuing NSBBs in Cirrhotic Patients With Managed Primary Aetiological Factors

Inclusion Criteria: * Aged 18 years or above * Evidence of cirrhosis, based on either radiological and/or clinical features * History of varices, variceal haemorrhage or portal hypertension warranting NSBB * Removal or suppression of the primary aetiological factor (i.e., sustained virological response in chronic hepatitis C, complete hepatitis B virus DNA suppression in chronic hepatitis B, and long-term alcohol abstinence in alcohol-related liver disease) * LSM \<25 kPa * Provision of written informed consent Exclusion Criteria: * Active aetiological factors not addressed in the inclusion criteria (e.g., autoimmune or hereditary liver diseases). However, hepatic steatosis-commonly coexisting with other liver diseases-is not an exclusion criterion unless accompanied by high plasma alanine aminotransferase \>40 U/L or confirmed steatohepatitis. * Recent hepatic decompensation within the past year (total bilirubin \>50 μmol/L, prothrombin time \>1.3 times the upper normal limit \[unless attributable to use of anti-coagulation\], albumin \<35 g/L, or presence of ascites, variceal haemorrhage or hepatic encephalopathy). Notably, the Baveno VI criteria used LSM \<20-25 kPa and normal platelet count \>150×109/L to rule out varices requiring treatment (19). However, in line with the Baveno VII consensus, which sets an LSM \<25 kPa as the threshold for considering NSBB discontinuation, thrombocytopenia is not an exclusion criterion to allow the cohort to include a wider spectrum of patients. * Current or history of hepatocellular carcinoma. * Radiological evidence of portal vein thrombosis. * History of other malignancies (unless in complete remission for \>5 years). * History of liver transplantation or liver resection. * Contraindications to undergoing endoscopy. * Other clinical indications for NSBB (e.g., cardiovascular disease, arterial hypertension)