{
  "abstract": "Background Patients with chronic liver disease and cirrhosis at risk of hepatocellular carcinoma (HCC) are living longer. Current guidelines provide no unified recommendations on when to stop HCC surveillance. We explored clinician practices and attitudes towards stopping HCC surveillance.Methods A 27-item web-based survey was administered between August and October 2025 and distributed via gastroenterology and hepatology society mailing lists and professional networks through study group contacts. Responses were analysed using chi-squared tests with adjustment for multiple comparisons.Results 504 clinicians from 23 countries across 6 continents completed the survey. Most were male (63%), gastroenterology/hepatology consultants (69%), working in metropolitan public hospitals (70%), and performed HCC surveillance using transabdominal ultrasound with alpha-fetoprotein (80%). Most respondents agreed that stopping HCC surveillance should be considered in older patients or those with limited life expectancy (81%), yet discussions with patients were infrequent (10% never; 34% rarely; 36% sometimes). Only 30% felt HCC guidelines provide useful recommendations on stopping surveillance. Major barriers included a lack of clear guidelines, fear of HCC development after stopping surveillance, and concern about giving patients mixed messages ( IDDF2026-ABS-0048 Figure 1. Barriers to initiating discussion about stopping HCC surveillance). Key patient factors influencing decisions were performance status, estimated life expectancy, comorbidities and ability to safely undergo HCC treatment (≥80% rated as important or very important) (IDDF2026-ABS-0048 Figure 2. Patient factors in the decision to stop HCC surveillance). Roughly half of respondents would not stop surveillance based on age alone in patients with cirrhosis (49%) or non-cirrhotic chronic hepatitis B (50%) if functional status was good (IDDF2026-ABS-0048 Figure 3. Age to stop HCC surveillance in a patient with good functional status). The most commonly nominated age to stop surveillance was 81–85 years (21%). Younger clinicians (<50 years and/or <5 years post-training) were more likely to prioritise age and nominate a specific cut-off. Respondents from Asia were more likely to continue surveillance in elderly patients or those with limited life expectancy (29% vs 16% strongly agree, p=0.002), whereas Western respondents were more likely to offer stopping surveillance (62% vs 26% strongly agree, p=0.002).Conclusions Clinicians recognise the appropriateness of stopping HCC surveillance in selected elderly patients, yet practice remains inconsistent and patient discussions are infrequent. Lack of guidance and fear of adverse consequences highlight a critical evidence gap to inform future guidelines.Abstract IDDF2026-ABS-0048 Figure 1Abstract IDDF2026-ABS-0048 Figure 2Abstract IDDF2026-ABS-0048 Figure 3",
  "authors": [
    {
      "affiliations": [
        "AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Australia"
      ],
      "name": "Georgia Zeng"
    },
    {
      "affiliations": [
        "AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Australia"
      ],
      "name": "Simone Strasser"
    },
    {
      "affiliations": [
        "AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Australia"
      ],
      "name": "Talal Valliani"
    },
    {
      "affiliations": [
        "Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong"
      ],
      "name": "Vincent WS Wong"
    },
    {
      "affiliations": [
        "Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong"
      ],
      "name": "Grace LH Wong"
    },
    {
      "affiliations": [
        "Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong"
      ],
      "name": "Terry CF Yip"
    },
    {
      "affiliations": [
        "BCLC Group, Liver Oncology Unit, Liver Unit, Institute Investigations, Hospital Clinic of Barcelona, Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, CIBERehd, Spain"
      ],
      "name": "Marco Sanduzzi Zamparelli"
    },
    {
      "affiliations": [
        "AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d’Hépato- gastroentérologie, Paris, France"
      ],
      "name": "Manon Allaire"
    },
    {
      "affiliations": [
        "Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States"
      ],
      "name": "Ju Dong Yang"
    },
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology, National University Health System, Singapore"
      ],
      "name": "Daniel Huang"
    },
    {
      "affiliations": [
        "Gastroenterology Service Intesto, Bern, Switzerland"
      ],
      "name": "Dominic Staudenmann"
    },
    {
      "affiliations": [
        "Department of Medicine, School of Clinical Medicine, The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong"
      ],
      "name": "Lung-Yi Mak"
    },
    {
      "affiliations": [
        "Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia"
      ],
      "name": "Wah Kheong Chan"
    },
    {
      "affiliations": [
        "Centre for Liver and Gastrointestinal Research, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Shishir Shetty"
    },
    {
      "affiliations": [
        "Department of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India"
      ],
      "name": "Anand Kulkarni"
    },
    {
      "affiliations": [
        "Yonsei University College of Medicine, Seoul, Korea, South"
      ],
      "name": "Hye Won Lee"
    },
    {
      "affiliations": [
        "Endemic Medicine and Hepatology Department, Capital University, Cairo, Egypt"
      ],
      "name": "Mohamed El-Kassas"
    },
    {
      "affiliations": [
        "MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"
      ],
      "name": "Ming-Hua Zheng"
    },
    {
      "affiliations": [
        "Department of Medical Oncology, ICESP - Instituto do Cancer DO Estado de Sao Paulo, Hospital das Clinicas, University of São Paulo School of Medicine, São Paulo, Brazil"
      ],
      "name": "Leonardo da Fonseca"
    },
    {
      "affiliations": [
        "Ajmera Transplant Program, University Health Network, Toronto, ON, Canada"
      ],
      "name": "Cynthia Tsien"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, University of the Philippines – Philippine General Hospital, Manila, Philippines"
      ],
      "name": "Mara Teresa Panlilio"
    },
    {
      "affiliations": [
        "Phramongkutklao Hospital and College of Medicine, Royal Thai Army, Bangkok, Thailand"
      ],
      "name": "Sakkarin Chirapongsathorn"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan"
      ],
      "name": "Nobuharu Tamaki"
    },
    {
      "affiliations": [
        "Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan"
      ],
      "name": "Yao-Chun Hsu"
    },
    {
      "affiliations": [
        "Gastroenterology Unit, Guillermo Almenara Hospital. Universidad Nacional Mayor de San Marcos, Lima, Peru"
      ],
      "name": "Maria Cecilia Cabrera"
    },
    {
      "affiliations": [
        "New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand"
      ],
      "name": "Hannah Giles"
    },
    {
      "affiliations": [
        "Division of Medicine & Royal Free London NHS Foundation Trust, Institute for Liver and Digestive Health, University College London, London, United Kingdom"
      ],
      "name": "Ankur Srivastava"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Liverpool, United Kingdom"
      ],
      "name": "Timothy Cross"
    },
    {
      "affiliations": [
        "AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Australia"
      ],
      "name": "Ken Liu"
    }
  ],
  "title": "IDDF2026-ABS-0048 Exploring practices and attitudes towards stopping hepatocellular carcinoma surveillance: a multinational clinician survey with over 500 respondents",
  "uid": "a77987d7-dd0b-59dd-b9a1-73c4389a583e"
}