{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:53:00Z","timestamp":1791557580373,"version":"4.3.4"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004761","name":"Natural Science Foundation of Hainan Province","doi-asserted-by":"publisher","award":["822MS195"],"award-info":[{"award-number":["822MS195"]}],"id":[{"id":"10.13039\/501100004761","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Aims<\/jats:title>\n                    <jats:p>International guidelines recommend initiating transjugular intrahepatic portosystemic shunt (TIPS) placement with an 8\u2010mm stent. However, there is an evident lack of randomized controlled trials evaluating TIPS diameters &lt;\u20098\u2009mm in cirrhotic patients with a relatively small liver. The aim of this study was to determine whether 7\u2009mm\u2010covered TIPS, compared with 8\u2010mm stents, could achieve comparable shunt function with a lower incidence of hepatic encephalopathy (HE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this multicenter randomized controlled trial, patients with cirrhosis and relatively small liver were randomized 1:1 to receive TIPS with a 7\u2010mm (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200992) or 8\u2010mm (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200992) covered stent to prevent variceal rebleeding. The primary endpoint was the incidence of overt HE after randomization. All\u2010cause rebleeding, orthotopic liver transplantation (OLT)\u2010free survival and a composite of these outcomes, were designated as secondary endpoints.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 184 enrolled patients, the predominant etiologies of liver cirrhosis were hepatitis B virus infection (56.0%) and alcohol\u2010related liver disease (20.7%). Over a median follow\u2010up of 26.5\u2009months, overt HE occurred in 19 patients (20.7%) in the 7\u2010mm group and 33 patients (35.9%) in the 8\u2010mm group. The 2\u2010year cumulative incidence of overt HE was significantly lower in the 7\u2010mm group than in the 8\u2010mm group (21.4% vs. 37.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Stent diameter, post\u2010TIPS portosystemic pressure gradient, pre\u2010covert HE and MELD\u2010Na score were identified as independent risk factors for overt HE. The rates of shunt dysfunction were statistically similar between groups (8.7% vs. 8.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.0), as were 2\u2010year rebleeding rates (10.9% vs. 9.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.81) and OLT\u2010free survival rates (91.3% vs. 88.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.82).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A 7\u2010mm covered TIPS demonstrated comparable shunt function to an 8\u2010mm covered stents, with a significantly lower risk of overt HE. These findings support consideration of 7\u2010mm TIPS stents for preventing variceal rebleeding in cirrhotic patients with a small liver who are undergoing TIPS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trail Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      , NCT02541825\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70875","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T04:50:06Z","timestamp":1789102206000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A 7\u2010mm Covered TIPS Reduces\u00a0Hepatic Encephalopathy Without Increasing Rebleeding in Cirrhotic Patients With Small Liver: A Randomized Study"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1972-7712","authenticated-orcid":false,"given":"Fuquan","family":"Liu","sequence":"first","affiliation":[{"name":"Liver Disease Center Hainan Hospital of Chinese PLA General Hospital  Sanya China"},{"name":"Interventional Therapy The Fifth Medical of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5736-9529","authenticated-orcid":false,"given":"Kan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Pulmonary and Critical Medicine The 8th Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Interventional Therapy, Beijing Shijitan Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2134-4814","authenticated-orcid":false,"given":"Quanwei","family":"He","sequence":"additional","affiliation":[{"name":"Liver Disease Center Hainan Hospital of Chinese PLA General Hospital  Sanya China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3560-1052","authenticated-orcid":false,"given":"Mingming","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Interventional Therapy, Beijing Shijitan Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Ma","sequence":"additional","affiliation":[{"name":"Interventional Therapy The Fifth Medical of Chinese PLA General Hospital  Beijing 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