{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T03:04:17Z","timestamp":1765422257204},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"award":["GERRAF"],"award-info":[{"award-number":["GERRAF"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>Current clinical guidelines by both American Association for the Study of Liver Disease and European Association for the Study of the Liver recommend endoscopy in all patients admitted with acute variceal bleeding within 12\u00a0hours of admission. Transjugular intrahepatic portosystemic shunt (TIPS) creation may be considered in patients at high risk if hemorrhage cannot be controlled endoscopically. We conducted a cross\u2010sectional observational study to assess how frequently TIPS is created for acute variceal bleeding in the United States without preceding endoscopy. Adult patients undergoing TIPS creation for acute variceal bleeding in the United States (n\u00a0=\u00a06,297) were identified in the last 10 available years (2007\u20102016) of the National Inpatient Sample. Hierarchical logistic regression was used to examine the relationship between endoscopy nonutilization and hospital characteristics, controlling for patient demographics, income level, insurance type, and disease severity. Of 6,297 discharges following TIPS creation for acute variceal bleeding in the United States, 31% (n\u00a0=\u00a01,924) did not receive first\u2010line endoscopy during the same encounter. Rates of \u201cno endoscopy\u201d decreased with increasing population density of the hospital county (nonmicropolitan counties 43%, n\u00a0=\u00a0114; mid\u2010size metropolitan county 35%, n\u00a0=\u00a0513; and central county with &gt;1\u00a0million population 23%, n\u00a0=\u00a0527) but not by hospital teaching status (n\u00a0=\u00a01,465, 32% teaching vs. n\u00a0=\u00a0430, 26% nonteaching; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.10). Higher disease mortality risk (odds ratio, 0.42; 95% confidence interval, 0.22\u20100.80; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.02) was associated with lower odds of noncompliance. <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>: One third of all patients undergoing TIPS creation for acute variceal bleeding in the United States do not receive first\u2010line endoscopy during the same encounter. Patients admitted to urban hospitals are more likely to receive guideline\u2010concordant care.<\/jats:p>","DOI":"10.1002\/hep4.1756","type":"journal-article","created":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T14:52:09Z","timestamp":1625151129000},"page":"1784-1790","update-policy":"http:\/\/dx.doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["High Prevalence of Transjugular Intrahepatic Portosystemic Shunt Creation Without Prior Endoscopy During Acute Variceal Bleeding Hospitalization in the United States"],"prefix":"10.1097","volume":"5","author":[{"given":"Premal S.","family":"Trivedi","sequence":"first","affiliation":[{"name":"Department of Radiology, Division of Interventional Radiology,University of Colorado Anschutz Medical Campus,Aurora,CO,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandria M.","family":"Jensen","sequence":"additional","affiliation":[{"name":"Colorado School of Public Health,Aurora,CO,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew A.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Interventional Radiology,University of Colorado Anschutz Medical Campus,Aurora,CO,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rustain L.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Interventional Radiology,University of Colorado Anschutz Medical Campus,Aurora,CO,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard C.","family":"Lindrooth","sequence":"additional","affiliation":[{"name":"Colorado School of Public Health,Aurora,CO,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert K.","family":"Ryu","sequence":"additional","affiliation":[{"name":"University of Southern California Keck School of Medicine,Los Angeles,CA,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. Michael","family":"Ho","sequence":"additional","affiliation":[{"name":"Veterans Affairs Eastern Colorado Health System,Aurora,CO,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Kriss","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,University of Colorado Anschutz Medical Campus,Aurora,CO,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2021,7,1]]},"reference":[{"key":"hep41756-bib-0001-20241015","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/MCG.0000000000000208","article-title":"The epidemiology of cirrhosis in the United States: a population\u2010based study","volume":"49","year":"2015","journal-title":"J Clin Gastroenterol"},{"key":"hep41756-bib-0002-20241015","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/hep.28906","article-title":"Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases","volume":"65","year":"2017","journal-title":"Hepatology"},{"key":"hep41756-bib-0003-20241015","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.gie.2006.08.023","article-title":"Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database","volume":"65","year":"2007","journal-title":"Gastrointest Endosc"},{"key":"hep41756-bib-0004-20241015","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.giec.2018.12.006","article-title":"Endoscopic management of portal hypertension\u2010related bleeding","volume":"29","year":"2019","journal-title":"Gastrointest Endosc Clin N Am"},{"key":"hep41756-bib-0005-20241015","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1055\/a-0628-7347","article-title":"Transjugular intrahepatic portosystemic shunt (TIPS): pathophysiologic basics, actual indications and results with review of the literature","volume":"190","year":"2018","journal-title":"Rofo"},{"key":"hep41756-bib-0006-20241015","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1053\/jhep.2003.50385","article-title":"Upper digestive bleeding in cirrhosis. 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