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Related Concept Videos

Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
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Related Experiment Video

Updated: Aug 9, 2025

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
07:10

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Individualized portal pressure gradient threshold based on liver function categories in preventing rebleeding after

Yifu Xia1,2, Jun Tie3, Guangchuan Wang2,4

  • 1Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.

Hepatology International
|February 22, 2023
PubMed
Summary

Optimal portal pressure gradient (PPG) after transjugular intrahepatic portosystemic shunt (TIPS) varies by liver function. A PPG <12 mmHg is suggested for Child-Pugh class B, while <14 mmHg may be best for Child-Pugh class C to prevent rebleeding.

Keywords:
Child–Pugh classCovered stentDecompensated liver cirrhosisHepatic encephalopathyIndividualized therapyMortalityPortal hypertensionPortal pressure gradientTransjugular intrahepatic portosystemic shuntVariceal rebleeding

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Area of Science:

  • Hepatology
  • Interventional Radiology
  • Gastroenterology

Background:

  • Evidence for portal pressure gradient (PPG) <12 mmHg after transjugular intrahepatic portosystemic shunt (TIPS) primarily stems from uncovered stent data.
  • Liver function, indicated by Child-Pugh class, influences tolerance to PPG reduction and risk of hepatic encephalopathy (HE).

Purpose of the Study:

  • To determine the optimal PPG target for covered TIPS.
  • To establish individualized PPG thresholds based on Child-Pugh classes to balance rebleeding risk and overt HE.

Main Methods:

  • A multicenter retrospective study analyzed 2100 patients undergoing TIPS.
  • Evaluated rebleeding, overt HE, and mortality in relation to post-TIPS PPGs (8, 10, 12, 14 mmHg).
  • Utilized propensity score matching and competing risk analyses for sensitivity.

Main Results:

  • Overall, PPG <12 mmHg reduced rebleeding post-TIPS (p=0.022).
  • In Child-Pugh class B, PPG thresholds of 12 mmHg and 14 mmHg predicted rebleeding, with 12 mmHg offering higher net benefit.
  • For Child-Pugh class C, PPG <14 mmHg showed lower rebleeding incidence (p=0.017) and greater net benefit than 12 mmHg.

Conclusions:

  • Optimal PPG targets after TIPS should be stratified by liver function.
  • A PPG threshold <12 mmHg may be appropriate for Child-Pugh class B patients.
  • A PPG threshold <14 mmHg may be optimal for Child-Pugh class C patients.