{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:42:09Z","timestamp":1790073729093,"version":"4.0.1"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:p>\n                    Gastroesophageal variceal bleeding in patients with cirrhosis is associated with significant morbidity and mortality, as well as a high rebleeding risk. Limited data are available on the role of transjugular intrahepatic portosystemic shunt (TIPS) with covered stents in patients receiving standard endoscopic, vasoactive, and antibiotic treatment. In this multicenter randomized trial, long\u2010term endoscopic variceal ligation (EVL) or glue injection\u2009+\u2009\u03b2\u2010blocker treatment was compared with TIPS placement in 72 patients with a first or second episode of gastric and\/or esophageal variceal bleeding, after hemodynamic stabilization upon endoscopic, vasoactive, and antibiotic treatment. Randomization was stratified according to Child\u2010Pugh score. Kaplan\u2010Meier (event\u2010free) survival estimates were used for the endpoints rebleeding, death, treatment failure, and hepatic encephalopathy. During a median follow\u2010up of 23 months, 10 (29%) of 35 patients in the endoscopy\u2009+\u2009\u03b2\u2010blocker group, as compared to 0 of 37 (0%) patients in the TIPS group, developed variceal rebleeding (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u20090.001). Mortality (TIPS 32% vs. endoscopy 26%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u20090.418) and treatment failure (TIPS 38% vs. endoscopy 34%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u20090.685) did not differ between groups. Early hepatic encephalopathy (within 1 year) was significantly more frequent in the TIPS group (35% vs. 14%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u20090.035), but during long\u2010term follow\u2010up this difference diminished (38% vs. 23%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u20090.121).\n                    <jats:italic toggle=\"yes\">Conclusions<\/jats:italic>\n                    : In unselected patients with cirrhosis, who underwent successful endoscopic hemostasis for variceal bleeding, covered TIPS was superior to EVL\u2009+\u2009\u03b2\u2010blocker for reduction of variceal rebleeding, but did not improve survival. TIPS was associated with higher rates of early hepatic encephalopathy. (H\n                    <jats:sc>epatology<\/jats:sc>\n                    2016;63:581\u2013589)\n                  <\/jats:p>","DOI":"10.1002\/hep.28318","type":"journal-article","created":{"date-parts":[[2015,10,30]],"date-time":"2015-10-30T19:34:55Z","timestamp":1446233695000},"page":"581-589","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":208,"title":["Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy\u2009+\u2009\u03b2\u2010blocker for prevention of variceal rebleeding"],"prefix":"10.1097","volume":"63","author":[{"given":"I. Lisanne","family":"Holster","sequence":"first","affiliation":[{"name":"Departments of Gastroenterology and Hepatology,Erasmus MC University Medical Center,Rotterdam,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric T.T.L.","family":"Tjwa","sequence":"additional","affiliation":[{"name":"Departments of Gastroenterology and Hepatology,Erasmus MC University Medical Center,Rotterdam,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriaan","family":"Moelker","sequence":"additional","affiliation":[{"name":"Departments of Radiology,Erasmus MC University Medical Center,Rotterdam,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Wils","sequence":"additional","affiliation":[{"name":"Departments of Radiology,Erasmus MC University Medical Center,Rotterdam,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina E.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Departments of Gastroenterology and Hepatology,Erasmus MC University Medical Center,Rotterdam,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Reinoud","family":"Vermeijden","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, and Meander MC, Amersfoort, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Scholten","sequence":"additional","affiliation":[{"name":"Sint Lucas Andreas Hospital,Amsterdam,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"van Hoek","sequence":"additional","affiliation":[{"name":"LUMC,Leiden,the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan J.","family":"Nicolai","sequence":"additional","affiliation":[{"name":"HagaHospital,Den Haag,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernst J.","family":"Kuipers","sequence":"additional","affiliation":[{"name":"Departments of Gastroenterology and Hepatology,Erasmus MC University Medical Center,Rotterdam,The Netherlands"},{"name":"Departments of Internal Medicine,Erasmus MC University Medical Center,Rotterdam,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.T.","family":"Pattynama","sequence":"additional","affiliation":[{"name":"Departments of Radiology,Erasmus MC University Medical Center,Rotterdam,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henk R.","family":"van Buuren","sequence":"additional","affiliation":[{"name":"Departments of Gastroenterology and Hepatology,Erasmus MC University Medical Center,Rotterdam,The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2015,12,28]]},"reference":[{"key":"hep28318-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1056\/NEJMra0901512","article-title":"Management of varices and variceal hemorrhage in cirrhosis","volume":"362","year":"2010","journal-title":"N Engl J Med"},{"key":"hep28318-bib-0002-20241017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1524-4733.2007.00208.x","article-title":"Estimates of costs of hospital stay for variceal and nonvariceal upper gastrointestinal bleeding in the United States","volume":"11","year":"2008","journal-title":"Value Health"},{"key":"hep28318-bib-0003-20241017","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.jhep.2010.06.004","article-title":"Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension","volume":"53","year":"2010","journal-title":"J Hepatol"},{"key":"hep28318-bib-0005-20241017","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1056\/NEJM199401203300303","article-title":"The transjugular intrahepatic portosystemic stent\u2010shunt procedure for variceal bleeding","volume":"330","year":"1994","journal-title":"N Engl J Med"},{"key":"hep28318-bib-0006-20241017","first-page":"CD000553","article-title":"Portosystemic shunts versus endoscopic therapy for variceal rebleeding in patients with cirrhosis","volume":"4","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"hep28318-bib-0007-20241017","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1053\/j.gastro.2003.11.016","article-title":"Improved clinical outcome using polytetrafluoroethylene\u2010coated stents for TIPS: results of a randomized study","volume":"126","year":"2004","journal-title":"Gastroenterology"},{"key":"hep28318-bib-0008-20241017","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1002\/hep.20386","article-title":"Influence of portal hypertension and its early decompression by TIPS placement on the outcome of variceal bleeding","volume":"40","year":"2004","journal-title":"Hepatology"},{"key":"hep28318-bib-0009-20241017","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jhep.2012.08.020","article-title":"Use of early\u2010TIPS for high\u2010risk variceal bleeding: results of a post\u2010RCT surveillance study","volume":"58","year":"2013","journal-title":"J Hepatol"},{"key":"hep28318-bib-0010-20241017","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1111\/apt.12934","article-title":"Early\u2010TIPSS placement prevents rebleeding in high\u2010risk patients with variceal bleeding, without improving survival","volume":"40","year":"2014","journal-title":"Aliment Pharmacol Ther"},{"key":"hep28318-bib-0011-20241017","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1056\/NEJMoa0910102","article-title":"Early use of TIPS in patients with cirrhosis and variceal bleeding","volume":"362","year":"2010","journal-title":"N Engl J Med"},{"key":"hep28318-bib-0012-20241017","first-page":"256","article-title":"Definitions, methodology and therapeutic strategies in portal hypertension. 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