{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T11:27:42Z","timestamp":1791026862522,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":244,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Hepatology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>There is evolving evidence regarding whether pre\u2010emptive transjugular intrahepatic portosystemic shunt (p\u2010TIPS) improves outcomes in patients with acute variceal bleeding. This meta\u2010analysis is aimed at evaluating the effectiveness of p\u2010TIPS compared with standard care in reducing mortality and rebleeding in high\u2010risk patients with cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched CENTRAL, MEDLINE, Embase, and ClinicalTrials.gov to identify randomized controlled trials (RCTs) comparing p\u2010TIPS placed within 72\u2009h of admission with standard care. All statistical analyses were performed using RevMan Version 5.4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six RCTs (\n                      <jats:italic>n<\/jats:italic>\n                      = 424 participants) met inclusion criteria. p\u2010TIPS significantly reduced all\u2010cause mortality (RR 0.54, 95% CI 0.39\u20130.76; ARR 14.9%; NNT \u2248 7) and rebleeding (RR 0.29, 95% CI 0.16\u20130.55; ARR 28.4%; NNT \u2248 4) compared with standard care, with consistent effects across variceal subtypes and degrees of hepatic decompensation. p\u2010TIPS also significantly reduced new or worsening ascites (RR 0.51, 95% CI 0.35\u20130.74), hepatorenal syndrome (RR 0.37, 95% CI 0.15\u20130.92), liver\u2010related mortality (RR 0.56, 95% CI 0.34\u20130.94), and serious adverse events (RR 0.72, 95% CI 0.59\u20130.88), without increasing hepatic encephalopathy (RR 1.01, 95% CI 0.72\u20131.43).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>p\u2010TIPS significantly reduced mortality and rebleeding risk in high\u2010risk patients with acute variceal bleeding, without increasing encephalopathy risk. These findings support its broader integration into clinical practice guidelines. Further large\u2010scale RCTs with extended follow\u2010up are warranted to define optimal patient selection, particularly in gastric variceal subgroups. PROSPERO: CRD420261329675<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/ijh\/3244544","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:50:41Z","timestamp":1788414641000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pre\u2010Emptive TIPS for Acute Variceal Bleeding: A Systematic Review and Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7674-6364","authenticated-orcid":false,"given":"Wan Muhammad Izhar bin Wan","family":"Ismail","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susmitha","family":"Chalamalasetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1651-4666","authenticated-orcid":false,"given":"Faraz","family":"Iqbal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0187-2529","authenticated-orcid":false,"given":"Karan","family":"Garg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6689-4342","authenticated-orcid":false,"given":"Aashni","family":"Purohit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hariniska Jayaraman","family":"Kannan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0524-9011","authenticated-orcid":false,"given":"Kalyanramnaidu","family":"Botsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basel","family":"Al Khatib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaseen","family":"Sulaiman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amar","family":"Abdalrazak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7773-2605","authenticated-orcid":false,"given":"Muhammad","family":"Safiullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8092-7072","authenticated-orcid":false,"given":"Asma\u2019a Munasar Ali","family":"Alsubari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7479-8495","authenticated-orcid":false,"given":"Adnan","family":"Bhat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Abu","family":"Zar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5353-2324","authenticated-orcid":false,"given":"Prasun K.","family":"Jalal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"e_1_2_11_1_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-33325-6"},{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.02.018"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01481.x"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.022"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000647"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20386"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0910102"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12934"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000613"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-020-07525-x"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000000865"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(25)00156-6"},{"key":"e_1_2_11_14_2","doi-asserted-by":"crossref","DOI":"10.1002\/9780470712184","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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