Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data

Abstract

See Covering the Cover synopsis on page 379.BACKGROUND AND AIMS: Current guidelines recommend surveillance for patients with nondysplastic Barrett's esophagus (NDBE) but do not include a recommended age for discontinuing surveillance. This study aimed to determine the optimal age for last surveillance of NDBE patients stratified by sex and level of comorbidity. METHODS: We used 3 independently developed models to simulate patients diagnosed with NDBE, varying in age, sex, and comorbidity level (no, mild, moderate, and severe). All patients had received regular surveillance until their current age. We calculated incremental costs and quality-adjusted life-years (QALYs) gained from 1 additional endoscopic surveillance at the current age versus not performing surveillance at that age. We determined the optimal age to end surveillance as the age at which incremental costeffectiveness ratio of 1 more surveillance was just less than

Failure to control variceal bleeding: Definition matters

“…Admittedly, and in spite of the overwhelming amount of data supporting the use of pTIPS, it is a fact that in the real-life setting the implementation of pTIPS is not as high as it should be. 7,8 Accordingly, the present study also shows the lack of implementation of pTIPS, which could justify the large number of patients reaching the point of requiring a rescue TIPS. Nevertheless, it would have been interesting to present these data (proportion of patients that would have fulfilled criteria for pTIPS) as a means of reinforcing the concept that, at least to some extent, the setting evaluated by the present study could have been avoided.…”

Safety, Efficacy, and Outcomes of N-Butyl Cyanoacrylate Glue Injection through the Endoscopic or Radiologic Route for Variceal Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

“…However, the prognosis depends on the general condition, the liver function reserve, and the associated comorbidities of the patient [ 64 , 65 , 66 , 67 ]. Current evidence supports the early use of TIPS for patient with cirrhosis and acute variceal bleeding [ 68 , 69 ]. Transjugular embolization of the varices at the time of TIPS can also be performed [ 3 , 4 , 6 , 70 , 71 , 72 ].…”

Management of the major complications of cirrhosis: Beyond guidelines

“…As such, acute HVPG response after AVB in those who are not deemed candidates for pre-emptive transjugular intrahepatic portosystemic shunt (TIPS), may best guide the medical strategy for secondary prophylaxis, albeit, further evidence is required to strongly recommend this approach. 52…”