{
  "abstract": "Introduction Pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) has been proposed to improve outcomes in patients at high risk for acute variceal bleeding; however, the extent and consistency of its benefits across various patient groups remain uncertain.Methods We searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing pre-emptive TIPS (placement within 72 hours) to standard therapy in adults with cirrhosis and acute variceal bleeding. The primary outcomes we focused on were all-cause mortality and rebleeding. Secondary outcomes included the incidence of new or worsening ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, liver-related mortality, and serious adverse events. We applied random-effects models for the analysis.Results Our analysis included six RCTs involving 431 patients. Pre-emptive TIPS significantly reduced all-cause mortality compared to standard care (Relative Risk [RR] = 0.54; 95% Confidence Interval [CI] = 0.39–0.76) and notably decreased the rate of rebleeding (RR = 0.29; 95% CI = 0.16–0.55). The benefits were consistent across different types of varices and varying degrees of baseline liver disease severity. Additionally, pre-emptive TIPS reduced the risks of new or worsening ascites, hepatorenal syndrome, liver-related death, and serious adverse events without increasing the incidence of hepatic encephalopathy. We did not observe any significant differences in rates of spontaneous bacterial peritonitis.Conclusions In high-risk patients with cirrhosis who are hospitalized for acute variceal bleeding, pre-emptive TIPS leads to substantial reductions in rebleeding and mortality and improves several important clinical outcomes without a corresponding rise in hepatic encephalopathy. These findings support the strategy of early TIPS placement for suitably selected patients.",
  "authors": [
    {
      "affiliations": [
        "London North West University Healthcare NHS Trust, London, United Kingdom"
      ],
      "name": "Wan Muhammad Izhar bin Wan Ismail"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals, United Kingdom"
      ],
      "name": "Faraz Iqbal"
    },
    {
      "affiliations": [
        "Internal Medicine Resident, St. Francis Medical Center, Monroe, United States"
      ],
      "name": "Susmitha Chalamalasetti"
    },
    {
      "affiliations": [
        "Surat Municipal Institute of Medical Education and Research, India"
      ],
      "name": "Karan Garg"
    },
    {
      "affiliations": [
        "KAP Viswanatham Government Medical College, India"
      ],
      "name": "Hariniska Jayaraman Kannan"
    },
    {
      "affiliations": [
        "Surat Municipal Institute of Medical Education and Research, India"
      ],
      "name": "Aashni Purohit"
    },
    {
      "affiliations": [
        "Sri Ramachandra Institute of Higher Education and Research, India"
      ],
      "name": "Kalyanram Naidu Botsa"
    },
    {
      "affiliations": [
        "College of Medicine, Alfaisal University, Saudi Arabia"
      ],
      "name": "Basel Al Khatib"
    },
    {
      "affiliations": [
        "Orthopedic Resident, Jordan University Hospital, Amman, Jordan"
      ],
      "name": "Yaseen Saad Sulaiman"
    },
    {
      "affiliations": [
        "Ophthalmology Resident, Jordan University Hospital, Amman, Jordan"
      ],
      "name": "Amar Mahmood Abdalrazak"
    },
    {
      "affiliations": [
        "Department of Medicine, King Edward Medical University, Lahore, Pakistan"
      ],
      "name": "Huzaifa Ahmad Cheema"
    }
  ],
  "title": "P120 Pre-emptive transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a systematic review and meta-analysis of randomized controlled trials",
  "uid": "d469c926-764d-5ab2-8680-47a8529a213f"
}