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Diameter of the shunt: the missing link in the appraisal of pTIPS in patients with cirrhosis with previous hepatic encephalopathy
  1. Thierry Thevenot1,
  2. Maxime Desmarets2,3,
  3. Delphine Weil1,
  4. Vincent Di Martino1
  1. 1 Service d’Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon, France
  2. 2 uMETh, Centre d’investigation Clinique 1431, Hôpital Jean Minjoz, Besançon, France
  3. 3 UMR1098 Right, Inserm, Établissement Français du Sang, Université Bourgogne-Franche-Comté, Besançon, France
  1. Correspondence to Professor Thierry Thevenot, Hôpital Jean Minjoz, Besancon, 25000, France; tthevenot{at}

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We read with interest the manuscript by Rudler et al.1 The authors reported a substudy of a multicentre prospective observational investigation evaluating acute variceal bleeding (AVB) in 2138 patients with cirrhosis (927 were at high risk of rebleeding, ie, Child-Pugh (CP) C 10–13 or CP B and active bleeding) between 2011 and 2015. Among 671 high-risk patients meeting the inclusion criteria for pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) placement, only 66 actually received this procedure, of whom 35 had hepatic encephalopathy (HE) at admission. Patients were followed for 1 year. The authors observed that the cumulative incidence of HE did not differ between patients who had had a previous episode of HE (n=15) and those who had not (n=51), in the subgroup of 66 high-risk patients receiving pTIPS. We …

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  • Contributors All the authors participated in the drafting of this Letter.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.