{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T10:18:34Z","timestamp":1784801914722,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2016,9,25]],"date-time":"2016-09-25T00:00:00Z","timestamp":1474761600000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and aims<\/jats:title><jats:p>American College of Gastroenterology and American Association for the Study of Liver Disease guidelines recommend endoscopic and pharmacologic treatment for esophageal variceal bleed. Transjugular intrahepatic portosystemic shunt (TIPS) placement is reserved for cases of therapeutic failure. Several studies have suggested improved prevention of rebleeding and improved survival without excess hepatic encephalopathy in patients who receive TIPS within the first 5\u2009days after bleeding (early TIPS). In this meta\u2010analysis, we evaluated the safety and efficacy of early TIPS versus endoscopic therapy for secondary prophylaxis after acute esophageal variceal bleeding in cirrhotic patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pubmed, Medline, Embase, ClinicalTrials.gov, and ISI Web of Science were searched for randomized controlled trials that compared early TIPS to endoscopic therapy. The primary outcome was mortality at 1\u2009year; secondary outcomes were rebleeding and hepatic encephalopathy at 1\u2009year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine randomized controlled trials involving 608 cirrhotic patients were identified. Early TIPS was associated with a significant risk reduction in 1\u2010year mortality (RR, 0.68; 95% CI, 0.49\u20100.96; <jats:italic>P<\/jats:italic>\u2009=\u20090.03) and 1\u2010year incidence of variceal rebleeding (RR, 0.28; 95% CI, 0.20\u20100.40; P\u2009&lt;\u20090.001) without significant heterogeneity among studies (I<jats:sup>2<\/jats:sup>\u2009=\u200930% and 47%, respectively). No significant difference in the incidence of hepatic encephalopathy at 1\u2009year was observed (RR, 1.36; 95% CI, 0.72\u20102.56; <jats:italic>P<\/jats:italic>\u2009=\u20090.34); however, there was significant heterogeneity among studies (I<jats:sup>2<\/jats:sup>\u2009=\u200968%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TIPS placed within 5\u2009days after a major esophageal variceal hemorrhage is superior to endoscopic treatment in reducing subsequent bleeding. Early TIPS placement is also associated with superior 1\u2010year survival without significantly increasing the incidence of hepatic encephalopathy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.13303","type":"journal-article","created":{"date-parts":[[2016,2,9]],"date-time":"2016-02-09T10:57:13Z","timestamp":1455015433000},"page":"1519-1526","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["Early TIPS versus endoscopic therapy for secondary prophylaxis after management of acute esophageal variceal bleeding in cirrhotic patients: a meta\u2010analysis of randomized controlled trials"],"prefix":"10.1111","volume":"31","author":[{"given":"Shadi Al","family":"Halabi","sequence":"first","affiliation":[{"name":"Internal Medicine Department Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"Sawas","sequence":"additional","affiliation":[{"name":"Department of Medicine Michigan State School of Medicine  East Lansing Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Besher","family":"Sadat","sequence":"additional","affiliation":[{"name":"Morsani College of Medicine University of South Florida  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiyah","family":"Jandali","sequence":"additional","affiliation":[{"name":"Section of Interventional Radiology Imaging Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadi Al","family":"Halabi","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi Al","family":"Halabi","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baljendra","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D","family":"Carey","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,9,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.giec.2007.03.005"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2000.03376.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2003.07294.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50385"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-009-0172-6"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21907"},{"issue":"3","key":"e_1_2_8_8_1","first-page":"III1","article-title":"UK guidelines on the management of variceal haemorrhage in cirrhotic patients. 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