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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. 1Service d’Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon, France
  2. 2uMETh, Centre d’investigation Clinique 1431, Hôpital Jean Minjoz, Besançon, France
  3. 3UMR1098 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}chu-besancon.fr

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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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Footnotes

  • 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.