{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:47:32Z","timestamp":1785934052325,"version":"3.56.0"},"reference-count":22,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"the New Clinical Technology Project of Xijing Hospital","award":["Grant No. 2024XJSM08"],"award-info":[{"award-number":["Grant No. 2024XJSM08"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,16]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hepatic encephalopathy (HE) is a major complication following transjugular intrahepatic portosystemic shunt (TIPS) placement, significantly affecting patients\u2019 quality of life and long-term prognosis. This study aims to compare the efficacy of underdilated TIPS versus standard TIPS in preventing variceal rebleeding in patients with cirrhosis and portal hypertension and to evaluate the incidence of post-procedural HE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This multicentre randomised controlled trial will be conducted across five Grade A tertiary hospitals in China. A total of 648 patients with portal hypertension-related oesophagogastric variceal bleeding undergoing TIPS will be enrolled and randomly assigned in a 1:1 ratio to either the experimental or control group. In the experimental group, underdilated TIPS will be performed using 6\u2009mm balloon for stent expansion. In the control group, standard TIPS will be performed using progressive balloon dilation, starting at 8\u2009mm and increasing stepwise as needed until the portosystemic pressure gradient is reduced to &lt;12\u2009mm Hg. The primary endpoint is the rebleeding rate over the entire follow-up period after TIPS. Secondary endpoints include the incidence of HE and liver function impairment. All statistical analyses will be performed using SPSS V.27.0 (IBM, Armonk, New York, USA), with a significance level set at p&lt;0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study protocol (V.2, 1 July 2025) has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Air Force Medical University (Approval No.: KY20252233-F-2). Written informed consent will be obtained from all participants prior to enrolment. Findings will be presented at academic conferences and published in peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ChiCTR2500110490;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07253389\">NCT07253389<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115218","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:18Z","timestamp":1785930918000},"page":"e115218","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of underdilated versus standard transjugular intrahepatic portosystemic shunt in preventing rebleeding from oesophagogastric varices in patients with cirrhosis in Chinese tertiary hospitals: protocol for a multicentre randomised controlled trial (UVR-TIPS trial)"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct07253389","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct07253389","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3570-2219","authenticated-orcid":false,"given":"Lei","family":"Liu","sequence":"first","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi\u2019an, China"},{"name":"Department of Infectious Diseases, Xijing Hospital, Air Force Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5438-1257","authenticated-orcid":false,"given":"Bo","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3653-5977","authenticated-orcid":false,"given":"Feng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9999-2422","authenticated-orcid":false,"given":"Wen","family":"Liang-Zhi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1209-7677","authenticated-orcid":false,"given":"Wentun","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0204-1193","authenticated-orcid":false,"given":"Xulong","family":"Yuan","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi\u2019an, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8964-1118","authenticated-orcid":false,"given":"Xiaoyuan","family":"Gou","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi\u2019an, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3439-1941","authenticated-orcid":false,"given":"Kai","family":"Li","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi\u2019an, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0059-5643","authenticated-orcid":false,"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, National Clinical Research 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