{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:16:30Z","timestamp":1788452190422,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T00:00:00Z","timestamp":1590451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Early\u2010transjugular intrahepatic porto\u2010systemic shunt (TIPSS) has been recommended in international guidelines for high\u2010risk patients with oesophageal variceal bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To validate the results of a previous randomised control trial which supports use of early\u2010TIPSS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a two\u2010centre open\u2010label parallel\u2010group randomised control trial, patients with cirrhosis and acute variceal bleeding were recruited following haemostasis with vaso\u2010active drugs and endoscopic band ligation. Participants were randomised to standard of care or early\u2010TIPSS. The primary outcome was 1\u2010year survival, secondary outcomes included early and late rebleeding, and complications of portal hypertension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010eight patients (58\u00a0\u00b1\u00a011.12\u00a0years; 32.7% female) were randomised. After one year, seven patients died in the standard of care group and six in the early\u2010TIPSS group, a 1\u2010year survival of 75.9% vs 79.3% respectively (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.79). Variceal rebleeding occurred in eight patients in the standard of care group compared with three patients in the early\u2010TIPSS group (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.09). Not all participants randomised to early\u2010TIPSS received the intervention in time. For those receiving TIPSS per\u2010protocol, variceal rebleeding rates were reduced (0% vs 27.6%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04) but this had no effect on survival (76.9% vs 75.9%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.91). Serious adverse events were similar in both treatment groups, except that rates of hepatic encephalopathy were higher in patients receiving TIPSS (46.1% vs 20.7%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Early\u2010TIPSS reduced variceal rebleeding, increased encephalopathy but had no effect on survival in high\u2010risk patients with oesophageal variceal bleeding. Early\u2010TIPSS may not be feasible in many centres however, larger studies are needed. ClinicalTrials.gov reference: NCT02377141.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.15797","type":"journal-article","created":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T08:21:02Z","timestamp":1590481262000},"page":"98-106","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":80,"title":["Randomised clinical trial: standard of care versus early\u2010transjugular intrahepatic porto\u2010systemic shunt (TIPSS) in patients with cirrhosis and oesophageal variceal bleeding"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2285-9663","authenticated-orcid":false,"given":"Philip D. 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