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Current guidelines recommend that patients with cirrhosis and variceal hemorrhage receive beta-blockers with or without long-acting nitrates and undergo surveillance endoscopy. A transjugular intrahepatic portosystemic shunt (TIPS) is reserved for patients who repeatedly fail these rebleeding-prevention strategies. Researchers have now assessed whether patients with advanced liver disease, who are at high risk for treatment failure and have a poor prognosis, might benefit from earlier TIPS placement.
At nine centers in Europe, the investigators enrolled 63 patients with cirrhosis and an initial episode of acute variceal hemorrhage who were being treated with vasoactive drugs, endoscopic therapy, and prophylactic antibiotics. All patients had…