Pre-emptive TIPS with 8-mm stents reduces hepatic encephalopathy without compromising efficacy in acute variceal bleeding
This multicenter study of 470 patients with cirrhosis and acute variceal bleeding shows that pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) placement using 8-mm stents reduces the 1-year incidence of overt hepatic encephalopathy by 43% compared to 10-mm stents, while maintaining similar efficacy in preventing rebleeding. Non-linear analysis identified a post-TIPS portacaval pressure gradient (PPG) range of 7-13 mmHg as an optimal target, minimizing risks of both overt hepatic encephalopathy and portal hypertensive complications. A significantly higher proportion of patients achieved this PPG range with 8-mm stents. These results address a key dilemma in high-risk AVB management, demonstrating that 8-mm stents balance encephalopathy prevention with effective portal decompression. The 7-13 mmHg PPG range provides a practical intraprocedural guide for individualized TIPS calibration, helping interventional radiologists optimize shunt diameter selection.
Authors
- Xuan Zhu
- Wei Bai (ORCID: https://orcid.org/0000-0001-9579-9959)
- Yan Zhao (ORCID: https://orcid.org/0000-0002-0638-4741)
- Jun Yang (ORCID: https://orcid.org/0000-0002-7460-2800)
- Yong Lv (ORCID: https://orcid.org/0000-0003-2745-3432)
- Guohong Han (ORCID: https://orcid.org/0000-0003-4568-3776)
- Junjun Ye
- Mingsheng Huang (ORCID: https://orcid.org/0000-0003-4749-4231)
- Dongdong Xia (ORCID: https://orcid.org/0000-0001-8664-2984)
- Wengang Guo (ORCID: https://orcid.org/0000-0001-8887-9352)
- Yuzheng Zhuge (ORCID: https://orcid.org/0000-0002-0649-4457)
- Zhenyu Wang (ORCID: https://orcid.org/0000-0002-5114-435X)
- Na Zhang (ORCID: https://orcid.org/0000-0001-6978-2731)
- Kai Li (ORCID: https://orcid.org/0000-0003-2963-005X)
- Wenguang Zhang (ORCID: https://orcid.org/0000-0003-4108-301X)
- Jun Wang (ORCID: https://orcid.org/0000-0002-1679-1922)
- Huahong Xie (ORCID: https://orcid.org/0000-0002-3413-503X)
- Daiming Fan (ORCID: https://orcid.org/0000-0002-2466-5002)
- Chunqing Zhang (ORCID: https://orcid.org/0000-0001-8711-1579)
- Weixin Ren
- Peng‐Xu Ding (ORCID: https://orcid.org/0000-0001-9595-5720)
- Yongzhan Nie (ORCID: https://orcid.org/0000-0003-1124-4548)
- Hui Xue (ORCID: https://orcid.org/0000-0003-3837-5361)
- Jianbo Zhao (ORCID: https://orcid.org/0000-0002-9263-4179)
- Zhanxin Yin (ORCID: https://orcid.org/0000-0003-4346-7551)
- Zhiping Yang (ORCID: https://orcid.org/0000-0001-7649-1385)
- Xiaoli Zhu
- Yanglin Pan (ORCID: https://orcid.org/0000-0002-7183-6716)
- Bohan Luo
Institutions
- Guiyang College of Traditional Chinese Medicine (CN)
- Nanchang University (CN)
- Xinjiang Medical University (CN)
- Shandong University (CN)
- Sun Yat-sen University (CN)
- First Affiliated Hospital of Xinjiang Medical University (CN)
- Northwest University (CN)
- Soochow University (CN)
- National Clinical Research Center for Digestive Diseases (CN)
- Nanfang Hospital (CN)
- Xi'an Medical University (CN)
- Affiliated Hospital of Guizhou Medical University (CN)
- Nanjing Drum Tower Hospital (CN)
- Shandong Provincial Hospital (CN)
- First Affiliated Hospital of Xi'an Jiaotong University (CN)
- Third Affiliated Hospital of Sun Yat-sen University (CN)
- First Affiliated Hospital of Soochow University (CN)
- First Affiliated Hospital of Zhengzhou University (CN)
- Xijing Hospital (CN)
- First Affiliated Hospital of Nanchang University (CN)
- Southern Medical University (CN)
- Air Force Medical University (CN)
Publication Details
- Journal
- JHEP Reports
- Published
- 2025-09-12
- DOI
- https://doi.org/10.1016/j.jhepr.2025.101591
- Primary Topic
- Liver Disease and Transplantation
- Type
- article
- Field-Weighted Citation Impact
- 0.00