A multicenter study recently published introduced a novel prognostic model for predicting esophagogastric variceal rebleeding after endoscopic treatment in patients with cirrhosis. The model incorporated six readily available clinical variables-albumin level, aspartate aminotransferase level, white blood cell count, ascites, portal vein thrombosis, and bleeding signs-and demonstrated promising predictive performance. However, limitations, including the retrospective design and exclusion of patients with hepatocellular carcinoma, may affect the generalizability of the model. Additionally, further improvement is needed in the model's discrimination between intermediate- and high-risk groups in external. Prospective validation and inclusion of additional variables are recommended to enhance predictive accuracy across diverse clinical scenarios.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886517PMC
http://dx.doi.org/10.3748/wjg.v31.i8.102841DOI Listing

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A multicenter study recently published introduced a novel prognostic model for predicting esophagogastric variceal rebleeding after endoscopic treatment in patients with cirrhosis. The model incorporated six readily available clinical variables-albumin level, aspartate aminotransferase level, white blood cell count, ascites, portal vein thrombosis, and bleeding signs-and demonstrated promising predictive performance. However, limitations, including the retrospective design and exclusion of patients with hepatocellular carcinoma, may affect the generalizability of the model.

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Trans-splenic anterograde coil-assisted transvenous occlusion (TACATO) of bleeding gastric varices associated with gastrorenal shunts in cirrhosis.

JHEP Rep

March 2025

Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Italy.

Background & Aims: There is a lack of consensus on the optimal management of fundal gastric varices (GVs) in patients with cirrhosis due to varied anatomy and hemodynamics. In this study, we evaluate the safety and efficacy of trans-splenic anterograde coil-assisted transvenous occlusion (TACATO) for preventing recurrent bleeding in fundal GVs associated with gastrorenal shunt (GRS).

Methods: In this 4-year study, patients with cirrhosis with GRS-associated GV bleeding, without prior esophageal variceal bleeding, ascites, or portal vein thrombosis, were eligible for TACATO.

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Purpose: Recurrent esophageal variceal bleeding and/or refractory ascites in patients with cavernous transformation of the portal vein (CTPV) is associated with a high fatality rate. Transjugular intrahepatic portosystemic shunt (TIPS) provides a treatment option for preventing esophageal variceal rebleeding and/or refractory ascites. This retrospective study evaluated the safety and efficacy of TIPS for the patients involved.

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Which patients benefit the most? An update on transjugular intrahepatic portosystemic shunt.

World J Hepatol

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Postgraduation Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Rio Grande do Sul, Brazil.

This is a narrative review in which the advances in technical aspects, the main indications, limitations and clinical results of the transjugular intrahepatic portosystemic shunt (TIPS) in portal hypertension (PH) are addressed. With the emergence of the coated prosthesis, a better shunt patency, a lower incidence of hepatic encephalopathy (HE) and better survival when compared to TIPS with the conventional prosthesis are demonstrated. The main indications for TIPS are refractory ascites, acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and, lastly, patients considered at high risk for rebleeding preemptive TIPS (pTIPS).

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Objectives: To compare the long-term efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with concurrent antegrade embolization in treating portal hypertension with oesophagogastric variceal bleeding in patients with and without large spontaneous portosystemic shunts (L-SPSSs).

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