Bleeding risk assessment of esophageal varices (EVs) is commonly performed in liver cirrhosis. However, existing approaches are often invasive or insufficient to fully capture bleeding risk. To investigate portal venous hemodynamics and vessel geometry associated with EVs severity in cirrhotic patients using four-dimensional flow MRI as a noninvasive approach to support clinical risk assessment. Retrospective. One-hundred and four cirrhotic patients consisting of patients without EVs (Group 1, n = 48), with low-risk EVs (Group 2, n = 37), and high-risk EVs (Group 3, n = 19). 3 T, a three-directional, velocity-encoded gradient echo sequence with Cartesian k-space sampling. Flow rate, mean velocity, and fractional flow changes in main portal vein (PV); effective vessel diameter and vessel angle; and rotational flow including vorticity, helicity, helical flow intensity (h 2), localized normalized helicity, and vortex volume. One-way ANOVA with Tukey's post hoc test or Kruskal-Wallis followed by Conover's post hoc test. Receiver operating characteristic (ROC) curve analysis. Significance level set at p < 0.05. Significant group differences were observed for flow rate at the proximal PV (ε 2 = 0.05) and for mean PV velocity at both proximal (ε 2 = 0.13) and distal locations (η 2 = 0.11). In contrast, neither fractional portal venous flow nor vessel angle measurements differed across groups (p = 0.294 and all p ≥ 0.475, respectively). Among rotational flow biomarkers, vorticity differentiated Group 3 from both Groups 1 and 2 (Group 1: 17.86 ± 3.26 s-1, Group 2: 16.65 ± 4.58 s-1, Group 3: 13.59 ± 3.23 s-1; η 2 = 0.15), with an area under the ROC curve of 0.77 (sensitivity = 0.79, specificity = 0.62). Rotational flow biomarkers may support current risk assessment in cirrhotic patients with high-risk EVs. 4. Stage 2.

To compare clinical outcomes of terlipressin as continuous versus bolus infusion for the management of acute variceal hemorrhage. Terlipressin is commonly used in the management of acute variceal bleeding, but evidence on the optimal method of administration-continuous infusion versus intermittent bolus-is limited. Patients presented with acute variceal bleeding were randomized into 2 arms: the intervention arm and the control arm received continuous and bolus infusion of terlipressin, respectively. Clinical endpoints included in-hospital mortality, 6-week mortality, the length of hospital stay, rebleeding and transfusion rates, and adverse events. Hemodynamic outcomes included were stability of heart rate, systolic, diastolic, and mean arterial blood pressures. A total of 128 patients were analysed. In-hospital mortality was none in both arms ( P =0.490). Mean length of stay for the intervention arm was 60.56±30.87 hours and the control arm was 57.80±33.35 hours ( P =0.569). Rebleeding was reported in 2 patients in each arm ( P =0.569). Packed cell transfusion rates were, 2.47±1.59 versus 2.17±0.98 units in intervention and control arm, respectively ( P =0.256). The 6-week mortality was 7 in the intervention and 12 in the control arms ( P =0.220). Bolus administration led to a greater reduction in heart rate at 4, 8, and post-20 hours ( P <0.05). Systolic blood pressure improved at 16 and 24 hours in the intervention arm ( P =0.02). There was no difference in length of hospital stay, packed cell volume, rebleeding, and mortality between both modes of terlipressin administration. Somewhat better improvement in systolic blood pressure was observed in patients who received a continuous infusion of terlipressin without any impact on clinical outcomes.

To develop and validate a model by incorporating abdominal multi-organ non-contrast computed tomography (CT) radiomics and clinical features to predict the feasibility of hepatic encephalopathy (HE) occurrence in patients with cirrhosis and hepatorenal failure. In total, 351 consecutive patients with cirrhosis and hepatorenal failure undergoing non-contrast abdominal CT scans at Centers 1 and 2 were enrolled. Patients from Center 1 were randomly allocated to training (n = 191) and internal test (n = 81) groups, and those from Center 2 were assigned to the external test group (n = 79). The nnU-Net framework was used for automated three-dimensional (3D) segmentation of abdominal organs-the liver, spleen, portal and splenic vein, inferior vena cava, esophagogastric junction, stomach, liver-adjacent small bowel, and colon. Segmented multi-organ radiomics features were extracted using 3D Slicer, with R software used for feature processing and model construction. Model performance in predicting HE occurrence was evaluated using receiver operating characteristic (ROC) analysis in the training, internal test, and external test cohorts. Decision curve analysis (DCA) was used to evaluate clinical utility. The SHapley Additive exPlanations (SHAP) tool was used to provide a basis for model interpretability analysis. In total, 351 patients (mean age, 61.3 ± 10.7 years; 231 men) were enrolled in this study. Esophageal variceal bleeding, peritonitis, and ascites were independent clinical predictors of HE. Twenty discriminative radiomics features, selected from the abovementioned multi-organs through intraclass correlation coefficient and least absolute shrinkage and selection operator analysis, were used to construct the radiomics model. The integrated model, incorporating both radiomics and clinical features, obtained higher areas under the ROC curve than the radiomics and clinical models in the training (0.87 vs. 0.83 vs. 0.68), internal test (0.85 vs. 0.81 vs. 0.66), and external test (0.83 vs. 0.78 vs. 0.72) cohorts, as evidenced by favorable integrated discrimination improvement values (P < 0.05 for all). The integrated model demonstrated superior clinical utility in DCA. Moreover, SHAP feature contribution analysis revealed that the top five features in terms of contribution were all extracted from the digestive tract. The integrated model can effectively predict HE occurrence in patients with cirrhosis and hepatorenal failure. This novel model, developed by integrating abdominal multi-organ non-contrast CT radiomics and clinical features, demonstrates robust performance in predicting the occurrence of cirrhosis-related HE in patients with cirrhosis and hepatorenal failure. It thus provides a valuable tool for clinical decision-making, facilitating the prevention of this complication.

Portal hypertension leads to the development of a complex and heterogeneous network of portosystemic collateral pathways, which represent adaptive responses to increased portal pressure. Although traditionally considered compensatory mechanisms, growing evidence indicates that Spontaneous Portosystemic Shunts (SPSS) are ineffective in normalizing portal pressure and may contribute to adverse clinical outcomes. In patients with cirrhosis, particularly those with preserved liver function, the presence and extent of SPSS are independently associated with hepatic encephalopathy, variceal bleeding, portal vein thrombosis, and reduced transplant-free survival, highlighting their prognostic relevance. Cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) plays a central role in the noninvasive assessment of portal hypertension by enabling comprehensive mapping of collateral circulation, including shunt size, anatomical course, and drainage pathways. These imaging characteristics are key determinants of clinical impact and therapeutic planning. This pictorial review illustrates the major portosystemic collateral pathways encountered in portal hypertension using representative clinical cases, emphasizing key imaging features and common diagnostic pitfalls, as well as highlighting the clinical significance in each context. Accurate recognition and standardized reporting of SPSS are essential to optimize risk stratification, guide management decisions, and improve outcomes in patients with portal hypertension.

Metabolic dysfunction-associated steatotic liver disease affects more than 30% of adults globally, yet effective treatment options remain limited. Tirzepatide has shown promise in early clinical trials, but its real-world effectiveness with liver-related outcomes remains uncertain. Using TriNetX Global Collaborative Network, adults with steatotic liver disease (SLD) and cardiometabolic dysfunction were identified between June 1, 2022, and April 25, 2025. Individuals newly prescribed tirzepatide were propensity score-matched 1:1 to controls not receiving tirzepatide. The primary outcome was major adverse liver outcomes (MALO), defined as decompensated liver events, hepatocellular carcinoma, or liver transplantation. Among 54,882 matched individuals, tirzepatide was associated with a lower incidence of MALO compared to the control group (HR, 0.32; 95% CI, 0.28-0.37). Tirzepatide use was associated with reductions in composite decompensated liver events (HR, 0.31; 95% CI, 0.26-0.36), esophageal variceal bleeding (HR, 0.39; 95% CI, 0.26-0.58), hepatic encephalopathy (HR, 0.27; 95% CI, 0.21-0.34), ascites-related complications (HR, 0.28; 95% CI, 0.23-0.33), hepatocellular carcinoma (HR, 0.36; 95% CI, 0.25-0.53), and liver transplantation (HR, 0.16; 95% CI, 0.08-0.33). Additionally, tirzepatide was associated with lower risks of all-cause mortality (HR, 0.22; 95% CI, 0.18-0.28), major adverse cardiac events (HR, 0.46; 95% CI, 0.40-0.52), and major adverse kidney events (HR, 0.26; 95% CI, 0.22-0.32). In this retrospective study, tirzepatide use was associated with substantially lower risks of liver-related complications among patients with SLD and cardiometabolic dysfunction, supporting the need for prospective validation of its potential hepatic benefits.

Esophagojejunal variceal bleeding after total gastrectomy is rare but potentially life-threatening, and no standard treatment has been established. Endoscopic variceal ligation (EVL) may be technically difficult for postoperative anastomotic lesions because of fibrosis. We report two cases of ruptured esophagojejunal anastomotic varices after total gastrectomy, for which hemostasis was successful with reopenable through-the-scope clips after failed EVL. Case 1 involved a 66-year-old man with metabolic dysfunction-associated steatohepatitis-related cirrhosis and history of total gastrectomy presenting with melena and hematemesis. Emergency endoscopy revealed bleeding from a jejunal anastomotic varix. EVL failed because of severe fibrosis, but hemostasis was achieved using reopenable clips. Subsequent endoscopic injection sclerotherapy confirmed blood flow interruption at the clip sites, with no rebleeding during the 2-year follow-up. Case 2 involved a 70-year-old man with alcohol-related cirrhosis and history of total gastrectomy who presented with hematemesis. Emergency endoscopy revealed active bleeding from the esophageal-side anastomotic varix. EVL failed because of fibrosis, but hemostasis was successful with four reopenable clips. No rebleeding was observed during the 4-month follow-up. Reopenable clips may represent a practical therapeutic option for bleeding esophagojejunal anastomotic varices with severe fibrosis when conventional EVL is technically difficult or unsuccessful.

Sequential rescue strategy in refractory acute esophageal variceal bleeding: a retrospective study.

Accurate pre-endoscopic risk stratification is essential in acute upper gastrointestinal bleeding (UGIB). Established scores predict mortality but have limited ability to identify patients requiring early therapeutic endoscopy. We developed and temporally validated a pre-endoscopic machine learning model to predict 30-day mortality and early (≤24h) endoscopic hemostatic intervention and assessed model interpretability. This retrospective cohort study included consecutive adults admitted with UGIB between November 2023 and November 2025. Only pre-endoscopic variables were considered. A gradient-boosted decision tree model was developed in a derivation cohort (n=762) and temporally validated in a subsequent cohort (n=353). Discrimination, calibration, decision curve analysis, SHAP-based explainability, and complete-case sensitivity analyses were assessed and compared with Glasgow-Blatchford, AIMS65, and ABC scores. Among 1115 patients (median age: 69y; 63.5% male; 19.0% variceal bleeding), 30-day mortality was 7.8% and early hemostatic intervention was 29.8%. In the validation cohort, the model achieved AUROCs of 0.874 for mortality and 0.848 for early intervention, with good calibration. Discrimination was significantly higher than established scores for both endpoints (all P<0.05). At a 20% intervention threshold, sensitivity was 84.9% and negative predictive value was 92.3%. Net benefit was greater across clinically relevant thresholds. SHAP analyses identified clinically plausible contributors, and complete-case analysis yielded similar performance. A pre-endoscopic machine learning model accurately predicted short-term mortality and early therapeutic endoscopy in UGIB, outperformed established risk scores, and showed interpretable feature-contribution patterns. External validation and prospective evaluation are warranted before clinical implementation.

There are limited data on hepatic recompensation in autoimmune hepatitis (AIH)-related decompensated cirrhosis. We evaluated incidence and predictors of recompensation and further decompensation, and assessed the impact of recompensation on survival. In this retrospective analysis of a prospectively maintained database, we included patients with AIH-related decompensated cirrhosis, confirmed by liver biopsy, who were treated with immunosuppression. Recompensation, defined by Baveno VII criteria (including etiological suppression), was analyzed using Fine and Gray competing-risk model with death as competing events. Secondary outcomes were all-cause mortality and further decompensation. Among 112 patients (71% women; mean age 41 ± 13years), 75% had ascites, 26% had variceal bleeding, and 13% had hepatic encephalopathy; median MELD-Na and CTP scores were 15.7 and 7, respectively. Prednisolone, azathioprine, and mycophenolate mofetil were used in 89%, 62% and 21% of patients, respectively. Over a median follow-up of 29months, 60 (54%) patients achieved recompensation. Younger age, lower CTP score, and biochemical response at 6months independently predicted recompensation, with biochemical response being the strongest predictor (sHR 1.75, 95% CI 1.02-2.88). After recompensation, 9 (15%) patients developed further decompensation (1- and 2-year incidence of 3.4% and 8.5%), whereas among 52 non-recompensated patients, 36 (69%) developed further decompensation and 16 (31%) remained in a stable decompensated state. Recompensation was associated with reduced mortality (HR 0.22, 95% CI 0.05-0.90) compared with non-recompensated patients. Over half of treated AIH-related decompensated cirrhosis can achieve recompensation with immunosuppression, which is associated with reduced mortality. Younger age, lower CTP score, and biochemical response predict recompensation.

Non-selective beta blockers (NSBBs) are well established for the prevention of variceal bleeding; however, their potential roles beyond this indication remain a matter of debate. We investigated the clinical outcomes of beta-blocker use in patients with cirrhosis after hospitalisation for cirrhotic complications, excluding variceal bleeding. Using the Korean National Health Insurance Service database, we conducted an emulated target trial among 7725 patients with viral hepatitis-related cirrhosis hospitalised for hepatic encephalopathy, hepatorenal syndrome, ascites, and/or spontaneous bacterial peritonitis (2013-2023), comparing beta-blocker users (n = 2455) and non-users (n = 5270). The primary outcome was all-cause death within 6 months; the secondary outcome was rehospitalisation within 3 months. Compared to beta-blocker non-users, those receiving beta-blocker therapy had a lower risk of all-cause death within 6 months [cumulative incidence of mortality 7.8% in beta-blocker users vs. 11.0% in non-users; adjusted hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.68-0.97]. A lower risk of all-cause death associated with beta-blocker use was observed across complication types and patient subgroups. When analysed by dose and agent, each compared with non-use, an association with lower mortality was observed for low-dose beta blockers (HR 0.75, 95% CI 0.59-0.94) and for carvedilol (HR 0.55, 95% CI 0.32-0.94), whereas associations for moderate-to-high-dose therapy (HR 0.90, 95% CI 0.71-1.15) and propranolol (HR 0.87, 95% CI 0.72-1.04) were not statistically significant. Non-selective beta blockerswere associated with reduced mortality and a modest reduction in all-cause readmission among patients with viral hepatitis-related cirrhosis after non-bleeding decompensating events (ClinicalTrials.gov: NCT06977685).

Rebleeding is a severe complication following recovery from esophageal variceal bleeding (EVB), yet robust predictive tools for assessing post-treatment risk after endoscopic variceal ligation (EVL) therapy remain scarce. This study developed and independently validated a machine learning (ML) model using multidimensional clinical data to predict 1-year rebleeding risk. Two independent cohorts were included: a retrospective cohort (n = 373) for model development and a prospective cohort (n = 119) for validation, with a one-year rebleeding endpoint. Predictors were identified using Recursive Feature Elimination (RFE), and eight ML algorithms were evaluated. Each algorithm was optimized via 5-fold cross-validation. The model with optimal performance was chosen to develop an online computational platform. RFE identified eight key predictors. The XGBoost model demonstrated superior predictive performance in both the training and validation cohorts, achieving AUCs of 0.883 and 0.887, respectively. This model was subsequently implemented in an online clinical platform for individualized 1-year rebleeding risk assessment. Our findings establish XGBoost as an effective tool for predicting EVB rebleeding risk, providing an evidence-based decision aid for post-EVL management.

Schistosomiasis is an emerging imported parasitic disease in Europe, but information on its clinical burden among hospitalized patients in non-endemic countries remains limited. To describe the epidemiology, clinical characteristics, complications, and outcomes of patients hospitalized with schistosomiasis in Spain using nationwide hospital discharge data, with a focus on sex-related differences. We conducted a retrospective observational study using the Spanish National Hospital Discharge Database (SNHDD). All hospitalizations with schistosomiasis (ICD-10: B65) recorded between 2016 and 2023 were included. Demographic characteristics, country of birth, clinical conditions, complications, and outcomes were analyzed. Urogenital, hepatosplenic, and intestinal complications were identified using ICD-10 codes. A total of 710 hospitalizations were identified; 550 (77.5%) occurred in men. Women were older than men (median age 46 vs. 34 years; p < 0.001) and had longer hospital stays (9 vs. 7 days; p = 0.041). Urogenital complications were more frequent in men, including bladder cancer (5.1% vs. 0.6%; p = 0.012), hematuria (5.8% vs. 1.3%; p = 0.017), cystitis (6.7% vs. 0.6%; p = 0.003), and obstructive uropathy (5.3% vs. 0%; p = 0.003). Male sex was independently associated with bladder cancer (aOR 16.31, 95% CI 2.12-125; p = 0. 0.007) and cystitis (adjusted OR 9.49, 95% CI 1.28-70; p = 0.028). Age was positively associated with bladder cancer (aOR 1.05, 95% CI 1.043-1.08; p < 0.001), and a lower probability of hematuria. (aOR 0.96, 95% CI 0.93-0.99; p = 0.005. In contrast, hepatosplenic complications were more frequent in women, including portal hypertension (12.5% vs. 4.5%; p < 0.001), esophageal varices (9.4% vs. 1.8%; p < 0.001), splenomegaly (5.6% vs. 1.5%; p = 0.002), and cirrhosis (6.3% vs. 2.7%; p = 0.033). Female sex was independently associated with portal hypertension (aOR 3.10, 95% CI 1.60-5.99), esophageal varices (aOR 7.11, 95% CI 2.92-17.30), and splenomegaly (aOR 5.46, 95% CI 1.88-15.92). ICU admission (8.6%) and in-hospital mortality (1.8%) did not differ significantly by sex. The overall hospitalization rate was 20 per million hospital admissions and was higher in men than in women (32.1 vs. 8.7 per million). Hospitalizations for schistosomiasis in Spain predominantly occur in men and are mainly associated with imported infections. Men more frequently present with urogenital complications, whereas women show a higher burden of hepatosplenic manifestations. These findings highlight the importance of increasing clinical awareness and implementing targeted screening and early diagnostic strategies in at-risk populations in non-endemic settings.

To assess whether contrast-enhanced ultrasound (CEUS)-derived intrahepatic transit times predict short-term hepatic decompensation in patients with compensated cirrhosis and to determine whether they provide incremental prognostic value over noninvasive markers. In this prospective study, 46 patients with compensated cirrhosis underwent CEUS with time-intensity curve analysis to determine hepatic artery-to-hepatic vein (HA-HVTT) and portal vein-to-hepatic vein (PV-HVTT) transit times. Liver stiffness and clinical scores (MELD, MELD 3.0, Child-Pugh, ALBI, FIB-4) were recorded. Patients were followed for 180 days to assess decompensation (ascites, variceal bleeding, or encephalopathy). Diagnostic performance was evaluated using ROC analysis, and prognostic value was assessed using Cox regression. Twenty-three patients developed decompensation. PV-HVTT and HA-HVTT were significantly shorter in patients who decompensated (p<0.001). PV-HVTT showed excellent discrimination (AUC 0.928), outperforming liver stiffness and clinical scores (all p<0.01). A PV-HVTT cutoff of 2.38 seconds identified high-risk patients with a 6-month decompensation rate of 83.3%, compared with 13.6% in low-risk patients. PV-HVTT independently predicted decompensation (HR 0.37 per 0.5 s increase, p<0.001). HA-HVTT showed moderate performance. CEUS-derived transit times predict short-term decompensation in compensated cirrhosis and outperform established noninvasive markers. CEUS provides a functional assessment of intrahepatic hemodynamics and may improve risk stratification.

Background:Gastric variceal bleeding is a common and serious complication of liver cirrhosis and carries a high mortality. Endoscopic variceal ligation (EVL) is widely used, but its efficacy for gastric varices is limited by incomplete variceal capture and a high rate of post-ligation rebleeding.Objectives:To evaluate the effectiveness and safety of metal clip-assisted endoscopic variceal ligation (MEVL) versus traditional ligation (TL) in adults with cirrhotic gastric varices.Design:Single-center retrospective observational cohort study, reported according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement.Methods:Adults with cirrhosis and gastroesophageal (gastroesophageal varices)-type varices undergoing elective ligation for primary or secondary prophylaxis at Henan Provincial People’s Hospital between May 2019 and December 2023 were included; emergency endoscopies were excluded. Non-selective beta-blocker co-therapy was standardized. Baseline imbalance was addressed by propensity score matching and inverse probability of treatment weighting (IPTW), pre-specified as the primary balancing method. Multivariable logistic regression, Cox proportional hazards modeling, and post hoc power were computed in SPSS 26 and Python 3.11.Results:Ninety-nine patients were analyzed (MEVL n = 46; TL n = 53) with comparable baseline characteristics. One-session eradication was achieved in 33 of 46 MEVL patients (71.7%) compared with 26 of 53 TL patients (49.1%), favoring MEVL after IPTW adjustment (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.03–6.27; p = 0.042) and on Cox regression (adjusted hazard ratio 1.53, 95% CI 1.00–2.35; p = 0.049). Early rebleeding between 120 h and 6 weeks occurred in 0 of 46 MEVL patients versus 5 of 53 TL patients (9.4%; p = 0.059; post hoc power 87%); the adjusted OR for any rebleeding favored MEVL (0.24, 95% CI 0.07–0.82; p = 0.023). All-cause mortality (3/46 vs 6/53) and adverse reactions (11/46 vs 14/53) did not differ.Conclusion:MEVL was associated with higher one-session eradication than TL, with no increase in adverse reactions. A reduction in cumulative rebleeding was suggested by adjusted logistic regression but was not confirmed by time-to-event Cox analysis; this finding should be interpreted as exploratory rather than definitive. Multicenter prospective validation is required.Clinical trial registration:Since this is a retrospective, non-randomized study, it was not registered as a clinical trial.

ABSTRACTBackgrounds and AimsUltrasound‐based spleen stiffness measurement (SSM) is a valid non‐invasive tool to assess portal hypertension (PH) in chronic liver disease. Whereas the role of the respiratory phase during liver stiffness measurements is established, no study has specifically addressed how respiration influences SSM by transient elastography.AimsTo evaluate the influence of respiration on SSM assessed with FibroScan 630 (Echosens, Paris, France).MethodsEighty‐three patients with chronic liver disease of different aetiologies underwent SSM using vibration‐controlled transient elastography (VCTE).ResultsSSM acquired during a normal respiratory cycle showed better diagnostic accuracy than measurements obtained during breath‐hold after deep inspiration (AUROC 0.835 [95% CI 0.743–0.928] vs. 0.798 [95% CI 0.697–0.899]).ConclusionSSM by VCTE should be performed during quiet breathing, as it showed good diagnostic accuracy for predicting the presence of oesophageal varices (OV) in patients with chronic liver disease.

Endoscopic variceal ligation versus cyanoacrylate injection for acute variceal bleeding from the cardia to the lesser curvature.

ABSTRACTBackground & AimsTransjugular intrahepatic portosystemic shunt (TIPS) improves survival in refractory ascites. A careful patient's selection is mandatory as TIPS can lead to complications. Liver volumetry is predictive of outcomes before hepatic surgery, but data on its role before TIPS placement are scarce. We aimed to evaluate whether liver and spleen volume measurements are associated with prognosis after TIPS placement in patients with ascites.MethodsWe analysed data from three French centers, treated with TIPS between 2017 and February 2022. Inclusion criteria encompassed a TIPS placement for refractory or recurrent ascites and availability of cross‐sectional imaging. Exclusion criteria included non‐cirrhotic portal hypertension, other indications for TIPS, hepatocellular carcinoma beyond Milan criteria, and extrahepatic malignancy. Liver and spleen volumes were measured using pre‐TIPS CT or MRI scans. The primary endpoint was 1‐year transplant‐free survival (TFS). Secondary endpoints were overt hepatic encephalopathy (HE), recurrence of ascites, acute variceal bleeding, and jaundice.ResultsThe 160 patients were included (median age 60 years, male gender 83.8%, alcohol‐related cirrhosis 58.8%, with active alcohol consumption in 25.6%, Child‐Pugh B cirrhosis in 81.2%, median MELD score was 12). The 1‐year TFS was 60.1%. Multivariate analysis identified serum creatinine (HR = 1.01 95% CI [1.00–1.01], p = 0.04), total bilirubin (HR = 1.02 95% CI [1.02–1.04], p = 0.004), and portal pressure gradient (HR = 1.09 95% CI [1.01–1.18], p = 0.03) as independent factors associated with TFS. Neither liver‐to‐spleen volume ratios (LSVR) (p = 0.36) nor liver volume index (p = 0.92) were significantly associated with death or LT. Overall, 38.1% of patients developed overt HE after TIPS, with lower platelet count (HR = 1.01 95% CI [1.00–1.01], p = 0.04) emerging as an independent predictor. No radiological characteristics were associated with the recurrence of ascites.ConclusionsIn this multicenter study, liver and spleen volumes were not associated with transplant‐free survival or liver‐related outcomes in patients undergoing TIPS for ascites. These findings suggest that liver volumetry should not be a determining factor in patient selection for TIPS placement.

Esophageal varices (EVs) are a major consequence of portal hypertension in patients with liver cirrhosis and are associated with substantial morbidity and mortality due to the risk of variceal hemorrhage. Early recognition of patients at increased risk for advanced varices is essential for preventing life-threatening bleeding. Thrombocytopenia is commonly observed in cirrhosis and has been investigated as a potential noninvasive marker for predicting the presence and severity of EVs. The objective of this study was to determine the correlation between platelet count and the grade of EVs in patients with liver cirrhosis. This hospital-based cross-sectional study was conducted in the Department of Medicine at Guru Gobind Singh Medical College and Hospital, Faridkot, after obtaining approval from the Institutional Research and Ethics Committee. A total of 100 patients with confirmed liver cirrhosis were enrolled. All participants underwent detailed clinical evaluation, laboratory investigations including platelet count, and upper gastrointestinal endoscopy for grading of EVs. Statistical analysis was performed using appropriate tests, and a P < 0.05 was considered statistically significant. The mean age of the study population was 49.8 ± 12.6 years. EVs were identified in 71% of patients. Mean platelet counts declined progressively with increasing variceal grade, from 148.6 ± 26.3 × 1099/L in patients without varices to 54.9 ± 16.2 × 1099/L in Grade III varices (P < 0.001). Platelet count demonstrates a significant inverse correlation with the grade of EVs. Thrombocytopenia may serve as a simple, noninvasive, and cost-effective predictor for identifying cirrhotic patients at higher risk of advanced varices, facilitating timely screening and management.

ABSTRACTSarcoidosis is a granulomatous disease that affects multiple organs, commonly the liver, with manifestations from asymptomatic disease to cirrhosis and liver failure. A 43‐year‐old male presented with generalized pruritus. Liver biopsy demonstrated findings consistent with sarcoidosis, and treatment was initiated. We emphasize timely follow‐up in hepatic sarcoidosis, including esophagogastroduodenoscopy.

Sarcopenia is associated with increased mortality and poor clinical outcomes in patients with liver cirrhosis. However, the correlation between sarcopenia and recompensation has not been determined until now. In this study, we aimed to evaluate the performance of sarcopenia in predicting recompensation in patients with decompensated cirrhosis. A total of 258 patients with decompensated cirrhosis were enrolled in this retrospective study, and the data of enrolled patients were collected and analyzed. 36.82% of patients with decompensated cirrhosis achieved recompensation. The etiology of liver cirrhosis in these patients included HBV, HCV, alcoholic liver disease, autoimmune liver diseases, schistosomiasis infection, and nonalcoholic fatty liver disease. The decompensating events in these patients included ascites (43.02%), esophagogastric variceal bleeding (42.25%), hepatic encephalopathy (5.23%), etc. 27.06% of decompensated patients with sarcopenia and 41.62% of patients without sarcopenia achieved recompensation. Univariate logistic analysis demonstrated several variables were associated with recompensation, including erythrocyte, hemoglobin, L3 skeletal muscle index (SMI), sarcopenia and subcutaneous fat area (SFA) (all p<0.05). Multivariate analysis demonstrated sarcopenia (OR=0.52; p=0.03) and hemoglobin (OR=1.02; p<0.01) were independent predictors for recompensation. Sarcopenia and hemoglobin were independent predictors for recompensation of decompensated patients, which helped to identify high-risk patients who have difficulty in achieving recompensation.