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Highlights • Malnutrition and poor muscle strength are highly prevalent in cirrhotics with hepatorenal syndrome. • Terlipressin infusion increased energy and protein intake in patients with hepatorenal syndrome. • Handgrip strength continued to increase with every day of terlipressin therapy • Medium to long-term terlipressin infusion was safe and efficacious as a bridge to liver transplant.

Background and Aim During COVID‐19 outbreak, restrictions to in‐person consultations were introduced with a rise in telehealth. An indirect benefit of telehealth could be better attendance. This study aimed to assess “failure‐to‐attend” (FTA) rate and satisfaction for two endoscopy‐related compulsory telehealth clinics during the COVID‐19 outbreak. Methods Consecutive patients booked for endoscopy‐related telehealth clinics at a tertiary hospital were prospectively assessed. In‐person clinic control data was assessed retrospectively. Sample size was calculated to detect an anticipated increase in attendance of 8%. Secondary outcomes included FTA differences between clinics and evaluation of patients and doctors satisfaction. Satisfaction was assessed based on 6 Likert scale questions used in previous telehealth research and asked to both patients and doctors (6Q_score). This study was exempt from IRB review after institutional IRB review. Results 691 patients were booked for appointments in our endoscopy clinics during the study periods (373 in 2020). FTA rates were lowered by half during the compulsory telehealth clinics (12.6% to 6.4%, p<0.01). The patient 6Q_score was higher for the Advanced Endoscopy clinic (84.6% versus 73.8%, p<0.01), while the doctor 6Q_score was similar between both Advanced and Post Endoscopy clinics (91.1% versus 92.5% respectively, p=0.80). An in‐person follow‐up consultation was suggested for 3.5% of the appointments, while the necessity of physical examination was flagged in 5.1%. Conclusions The use of phone consultations in endoscopy‐related clinics during the COVID‐19 outbreak has improved FTA rates while demonstrating high satisfaction rates. The need for in‐person follow‐up consultations and physical examination were low.

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conceptualized and designed the study. Sujievvan Chandran was responsible for the study supervision. All authors were involved in data extraction. Leonardo Zorron Cheng Tao Pu and Ryma Terbah were involved in the statistical analyses. All authors helped with interpretation of the results and drafting the manuscript. Rhys Vaughan, Marios Efthymiou, and Sujievvan Chandran carried the critical revision of the article for important intellectual content. All authors read and approved the final version of the manuscript.