Editorial: early TIPSS in patients with cirrhosis and acute variceal bleeding—the plot thickens!

Abstract

Hence, these findings on absolute risk of pancreatic cancer are in fact reassuring of the low risk of pancreatic cancer in patients with IBD. The one group of patients that merits close attention are patients with PSC. The investigators observed a 7.5-fold higher risk of pancreatic cancer in patients with PSC-IBD as compared to patients without IBD or PSC, with a higher risk in patients with short-duration PSC (<5 years after PSC diagnosis). These findings are striking. It is probable that a substantial proportion of these patients may in fact have intra-ductal cholangiocarcinoma that can be misclassified as pancreatic cancer in administrative claims databases. An independent association between PSC and pancreatic cancer has been inconsistently reported, and surveillance specifically for pancreatic cancer is not recommended in patients with PSC. 5,6 In summary, with an elegant binational population-based cohort study, Everhov and colleagues have settled two issues-that patients with IBD may have an increased risk of pancreatic cancer, but that they should not lose sleep over it.

Antibiotic prophylaxis in cirrhosis patients with upper gastrointestinal bleeding: An updated systematic review and meta‐analysis

“…Furthermore, the "standard-of-care" for variceal bleeding has improved over the years with increasing use of potent nonselective beta-blocker such as carvedilol, endoscopic ligation, early transjugular intrahepatic portosystemic shunt and early access to the ICU. 38 These collective improvements may further dilute the survival benefit of antibiotic prophylaxis alone in cirrhosis patients with UGIB. In this study, we addressed this gap by reaffirming the survival benefit of prophylactic antibiotics in cirrhosis patients with UGIB.…”

“…While antibiotics may reduce infection‐related mortality by preventing the risk of infection, none of the included studies reported infection‐related complications such as acute‐on‐chronic liver failure or hepatorenal syndrome following UGIB. Furthermore, the “standard‐of‐care” for variceal bleeding has improved over the years with increasing use of potent nonselective beta‐blocker such as carvedilol, endoscopic ligation, early transjugular intrahepatic portosystemic shunt and early access to the ICU 38 . These collective improvements may further dilute the survival benefit of antibiotic prophylaxis alone in cirrhosis patients with UGIB.…”

Economic evaluation of covered stents for transjugular intrahepatic portosystemic stent shunt in patients with variceal bleeding and refractory ascites secondary to cirrhosis

“…It concluded that large multicentre RCTs are necessary to draw firm conclusions on survival benefit of TIPSS in all high‐risk groups. 34 …”

“…It concluded that large multicentre RCTs are necessary to draw firm conclusions on survival benefit of TIPSS in all high-risk groups. 34 The RA indication was also limited by the use of the single study by Bureau et al 11 to inform the majority of parameter values. Again, there were limitations with study size (n=62) and also generalisability of French data to the UK setting.…”