Evidence map›Paper›PMID 41503572›Full record

ArticleJHEP reports : innovation in hepatology2026

Shunt magnitude is a key determinant of overt hepatic encephalopathy in patients undergoing TIPS.

Davide Roccarina, Dario Saltini, Marco Senzolo, Silvia Nardelli, Martina Rosi, Valentina Adotti, Marcello Bianchini, Lara Biribin, Stefania Gioia, Cristian Caporali and 22 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JHEP reports : innovation in hepatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Neoadjuvant Under-Dilated TIPS: Expanding Surgeries for Extrahepatic Malignancies in Patients With Cirrhosis and CSPH.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

32 authors.

Davide RoccarinaDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Dario SaltiniSevere Liver Diseases Departmental Unit (M.E.C.), AOU Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Marco SenzoloUnit of Vascular Liver Diseases and Treatment of Portal Hypertension, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy.
Silvia NardelliDepartment of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Martina RosiDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Valentina AdottiDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Marcello BianchiniSevere Liver Diseases Departmental Unit (M.E.C.), AOU Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Lara BiribinUnit of Vascular Liver Diseases and Treatment of Portal Hypertension, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy.
Stefania GioiaDepartment of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Cristian CaporaliInterventional Radiology Unit, AOU Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Lucia RagozzinoDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Tomas GuasconiSevere Liver Diseases Departmental Unit (M.E.C.), AOU Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Margherita FalciniDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Federico CasariInterventional Radiology Unit, AOU Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Antonio PiscopoSevere Liver Diseases Departmental Unit (M.E.C.), AOU Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Francesco PindozziDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Stefano GittoDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Silvia AspiteDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Gianmarco FalconeDepartment of Radiology, Interventional Radiology Unit, Careggi Hospital, Florence, Italy.
Angelica IngravalloDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Melania GagginiInstitute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy.
Kymentie FerdinandeUnit of Vascular Liver Diseases and Treatment of Portal Hypertension, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Padua, Italy.
Umberto ArenaDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Manuela MerliDipartimento di Scienze Biotecnologiche Medico Chirurgiche, Sapienza University of Rome, Rome, Italy.
Lorenzo RidolaDepartment of Integrated Diagnostic Services DIDAS, University Hospital of Padua, Padua, Italy.
Oliviero RiggioDepartment of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Fabrizio FanelliDepartment of Radiology, Interventional Radiology Unit, Careggi Hospital, Florence, Italy.
Chiara ManginiDepartment of Medicine (DIMED), University of Padova, Padova, Italy.
Fabio MarraDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Sara MontagneseDepartment of Medicine (DIMED), University of Padova, Padova, Italy.
Filippo SchepisSevere Liver Diseases Departmental Unit (M.E.C.), AOU Policlinico of Modena, University of Modena and Reggio Emilia, Modena, Italy.
Francesco VizzuttiDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background & Aims: Under-dilated transjugular intrahepatic portosystemic shunts (U-TIPS) has been proposed to reduce the risk of overt hepatic encephalopathy (OHE) while effectively treating portal hypertension (PH) complications. In this study we assessed how end-procedural porto-caval pressure gradient (PCPG), obtained in sedated patients, and endoprosthesis dilation affect the risk of OHE after TIPS. Methods: Consecutive patients with cirrhosis receiving TIPS for refractory ascites or recurrent PH-related bleeding were enrolled. OHE within 1-year was analyzed using a competing risk model, accounting for death and liver transplantation. Adequate hemodynamic response (AHR) was defined as post-TIPS PCPG <12 mmHg or reduction ≥60% in refractory ascites, and <12 mmHg or reduction ≥50% in PH-related bleeding. PCPG values outside of the above criteria were considered as inadequate response. U-TIPS was defined as endoprosthesis dilation ≤7 mm, as opposed to standard TIPS (S-TIPS). Results: Among 408 patients enrolled, 50% received U-TIPS, 63% achieved AHR, and 46% had a PCPG <10 mmHg. One-year cumulative incidence of OHE was 33% and 50% in U-TIPS and S-TIPS, respectively ( Conclusions: The magnitude of the shunt emerges as an independent key determinant of post-TIPS OHE. Impact and implications: TIPS carries a significant risk of overt hepatic encephalopathy. Low portosystemic pressure gradient and larger shunt diameter have been reported to increase the risk of overt hepatic encephalopathy. The TIPS dilation diameter represents an independent key determinant of post-TIPS overt hepatic encephalopathy. Thus, TIPS under-dilation reduces overt hepatic encephalopathy occurrence while effectively controlling portal hypertension complications even without meeting established hemodynamic targets.

Indexed as

Overt hepatic encephalopathyPortal hypertensionPorto-caval pressure gradientUnder-dilated endoprosthesis

Identifiers

PMID41503572
PMCPMC12769790

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