p-TIPS must be the treatment of choice in CP-C patients with AVB. Due to the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients. This article is protected by copyright. All rights reserved.

Acute-on-chronic liver failure (ACLF) AVB + ACLF High rebleeding rate (25.2%) in 42 days High mortality rate (51.0%) in 42 days Pre-emptive TIPS in AVB + ACLF Low rebleeding rate (4.5%) in 42 days Low mortality rate (13.6%) in 42 days Pre-emptive TIPS Acute Variceal Bleeding (AVB) Highlights Variceal bleeding is frequently associated with ACLF in cirrhosis. ACLF is independently associated with rebleeding and mortality. Patients with variceal bleeding and ACLF can benefit from a preemptive (early) TIPS.

See Covering the Cover synopsis on page 379.BACKGROUND AND AIMS: Current guidelines recommend surveillance for patients with nondysplastic Barrett's esophagus (NDBE) but do not include a recommended age for discontinuing surveillance. This study aimed to determine the optimal age for last surveillance of NDBE patients stratified by sex and level of comorbidity. METHODS: We used 3 independently developed models to simulate patients diagnosed with NDBE, varying in age, sex, and comorbidity level (no, mild, moderate, and severe). All patients had received regular surveillance until their current age. We calculated incremental costs and quality-adjusted life-years (QALYs) gained from 1 additional endoscopic surveillance at the current age versus not performing surveillance at that age. We determined the optimal age to end surveillance as the age at which incremental costeffectiveness ratio of 1 more surveillance was just less than

Idiopathic noncirrhotic portal hypertension is a heterogeneous group of diseases characterized by portal hypertension in the absence of cirrhosis. The efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in this population are unknown. The charts of patients with idiopathic noncirrhotic portal hypertension undergoing TIPS in seven centers between 2000 and 2014 were retrospectively reviewed. Forty-one patients were included. Indications for TIPS were recurrent variceal bleeding (n 5 25) and refractory ascites (n 5 16). Patients were categorized according to the presence (n 5 27) or absence (n 5 14) of significant extrahepatic comorbidities. Associated conditions were hematologic, prothrombotic, neoplastic, immune, and exposure to toxins. During follow-up (mean 27 6 29 months), variceal rebleeding occurred in 7/25 (28%), including three with early thrombosis of the stent. Post-TIPS overt hepatic encephalopathy was present in 14 patients (34%). Eleven patients died, five due the liver disease or complications of the procedure and six because of the associated comorbidities. The procedure was complicated by hemoperitoneum in four patients (10%), which was fatal in one case. Serum creatinine (P 5 0.005), ascites as indication for TIPS (P 5 0.04), and the presence of significant comorbidities (P 5 0.01) at the time of the procedure were associated with death. Mortality was higher in patients with significant comorbidities and creatinine 100 lmol/L (P < 0.001). Conclusion: In patients with idiopathic noncirrhotic portal hypertension who have normal kidney function or do not have severe extrahepatic conditions, TIPS is an excellent option to treat severe complications of portal hypertension. (HEPATOLOGY 2016;64:224-231) I diopathic noncirrhotic portal hypertension (INCPH) is a heterogeneous group of rare diseases characterized by portal hypertension (PHT) without cirrhotic changes, without a cause of chronic liver disease, and without venous obstruction.(1,2) Various histologic changes may be present, including nodular regenerative hyperplasia, hepatoportal sclerosis or obliterative portal venopathy, sinusoidal dilatation, and Abbreviations: HE, hepatic encephalopathy; INCPH, idiopathic noncirrhotic portal hypertension; PHT, portal hypertension; PVT, portal vein thrombosis; TIPS, transjugular intrahepatic portosystemic shunt.

Introduction: Benefit and risk of anticoagulation in cirrhotic patients with portal vein thrombosis (PVT) remain controversial, especially in those with asymptomatic PVT and in non-liver transplant candidates. Furthermore, the predictors of portal vein recanalization and bleeding events after anticoagulation are critical for making clinical decisions, but still unclear. We conducted a meta-analysis to investigate the outcomes of anticoagulation for PVT in liver cirrhosis and explore the predictors of portal vein recanalization and bleeding events after anticoagulation. Methods: All studies regarding anticoagulation for PVT in liver cirrhosis were searched via PubMed, EMBASE, and Cochrane Library databases. Thrombotic outcomes, bleeding events, and survival were compared between anticoagulation and non-anticoagulation groups. Predictors of portal vein recanalization and bleeding events were pooled. Risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Results: Thirty-three studies including 1696 cirrhotic patients with PVT were included. Anticoagulation significantly increased portal Electronic supplementary material The online version of this article (

In patients with chronic noncirrhotic, nontumoral portal vein thrombosis (PVT), the usually recommended strategy for endoscopic screening and management of varices is the same as in cirrhosis. However, the efficacy of this policy in patients with PVT is unknown. We assessed the course of gastroesophageal varices in a large cohort of patients with chronic PVT. Patients prospectively registered in two referral centers for vascular liver disorders were eligible for the study. Endpoints were development and growth of varices and the incidence and outcome of portal hypertensionrelated bleeding. Included were 178 patients with chronic PVT. Median follow-up was 49 (1-598) months. Variceal bleeding was the initial manifestation in 27 (15%) patients. Initial endoscopy in the remaining 151 patients showed no varices in 52 (34%), small esophageal varices in 28 (19%), large esophageal varices (LEVs) in 60 (40%), and gastric varices without LEVs in 11 (7%). Ascites and splenomegaly were independent predictors for the presence of varices. In patients without varices, the probability of developing them was 2%, 22%, and 22% at 1, 3, and 5 years, respectively. In those with small esophageal varices, growth to LEVs was observed in 13%, 40%, and 54% at 1, 3, and 5 years, respectively. In patients with LEVs on primary prophylaxis, probability of bleeding was 9%, 20%, and 32% at 1, 3, and 5 years, respectively. Nine (5%) patients died after a median 51 (8-280) months, only one due to variceal bleeding. Conclusions: The course of varices in chronic noncirrhotic, nontumoral PVT appears to be similar to that in cirrhosis; using the same therapeutic approach as for cirrhosis is associated with a low risk of bleeding and death. (HEPATOLOGY 2016;63:1640-1650 C hronic noncirrhotic, nontumoral portal vein thrombosis (PVT) is a rare vascular disorder of the liver, with variceal bleeding being its main manifestation. (1,2) Indeed, several retrospective cohort studies have shown a high prevalence of esophageal varices (EVs) at the time of chronic PVT diagnosis. (3,4) Due to the low incidence and prevalence of PVT, specific studies aimed at determining adequate strategies for endoscopic screening and management of varices are scarce and small-sized. Consequently, the 2015 Baveno VI Consensus suggested applying to patients with PVT the same recommendations validated for patients with cirrhosis and portal hypertension, i.e., to perform a baseline endoscopy at diagnosis of PVT and subsequent endoscopies at 2-year or 3-year intervals in patients with no EVs or small EVs (SEVs) at baseline, to use beta-blockers or endoscopic band ligation (EBL) as a primary prophylaxis, and to Abbreviations: EBL, endoscopic band ligation; EV, esophageal varix; GOV, gastroesophageal varix; GV, gastric varix; IGV, isolated gastric varix; LEV, large esophageal varix; NSBB, nonselective beta-blocker; PVT, portal vein thrombosis; SEV, small esophageal varix.

Objectives To compare the number of patients attending the Urology Emergency Department (ED) of the Centro Hospitalar Universitário do Porto (CHUP), as well as their demographic characteristics, the reasons for admission, the clinical severity under the Manchester triage system (MTS), and the need for emergency surgery or hospitalisation, during the coronavirus disease 2019 (COVID‐19) pandemic and the equivalent period in 2019. Patients and methods Data were collected from patients attending the Urology ED of the CHUP over 3 weeks, from 11 March to 1 April 2020, and from the same period in the previous year (from 11 March to 1 April 2019). Results During the pandemic, 46.4% fewer patients visited our urological ED (122 vs 263). There was no significant difference in the mean age or the number of old patients (aged ≥65 years) between the two periods. However, significantly fewer female patients sought emergency urological services during the COVID‐19 pandemic period (32.7% vs 14.8%, P < 0.05). No significant differences were noted between different clinical severity groups under the MTS. In 2019, significantly less patients required hospitalisation. The most common reasons for admission, during both periods, were haematuria, renal colic and urinary tract infections. The authors recognise that the study has several limitations, namely, those inherent to its retrospective nature. Conclusion COVID‐19 significantly influenced people’s urological care‐seeking behaviour. Understanding the present situation is helpful for predicting future urological needs. Based on the results of this study, we have reason to speculate that people’s requirements for urological services might grow explosively in the post‐COVID‐19 period. There should be further studies about the real state of long‐term urological services and the consequences that this pandemic may have in terms of morbimortality not directly related to the severe acute respiratory syndrome coronavirus 2.

Background and aims: The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial. There are few prospective studies validating risk factors for development of PVT. We analysed the incidence, factors associated with PVT development and its influence on cirrhosis decompensations and orthotopic liver transplant (OLT)-free survival. Methods: In this prospective observational study between January 2014 and March 2019, 445 consecutive patients with chronic liver disease were screened and finally 241 with cirrhosis included. Factors associated with PVT development and its influence on cirrhosis decompensations and OLT-free survival by time dependent covariate coding were analysed. Results: Majority of patients belonged to Child-Pugh class A 184 (76.3%) and the average MELD score was 10 ± 5. Previous cirrhosis decompensations occurred in 125 (52.1%), 63 (26.1%) were on NSBB and 59 (27.2%) had undergone banding for bleeding prophylaxis. Median follow-up was 29 (1-58) months. Cumulative incidence of PVT was 3.7% and 7.6% at 1 and 3 years. Previous decompensation of cirrhosis and low platelet counts but not NSBB independently predicted the development of PVT. During follow-up, 82/236 (34.7%) patients developed cirrhosis decompensations.OLT-free survival was 100% and 82.8% at 3 years, with and without PVT respectively. MELD score, but not PVT, independently predicted cirrhosis decompensations (HR 1.14; 95%CI:1.09-1.19) and OLT-free survival (HR 1.16;95%CI:1.11-1.21).