A 7-mm TIPS Halved Encephalopathy Risk Without Sacrificing Rebleeding Control: Liver International | October 2026

What Did the Study Find?

Investigators randomised 184 patients with cirrhosis, previous variceal bleeding, and a relatively small liver to covered TIPS created with a 7-mm or 8-mm stent. Median follow-up was 26.5 months; hepatitis B accounted for 56% of cirrhosis.

Overt hepatic encephalopathy developed in 20.7% with 7-mm versus 35.9% with 8-mm TIPS, an absolute reduction of 15.2 percentage points. Two-year cumulative incidence was 21.4% versus 37.2% (HR 0.52), while recurrent encephalopathy fell from 13.0% to 4.3%. Importantly, smaller diameter did not compromise efficacy: two-year rebleeding was 10.9% versus 9.8%, shunt dysfunction was 8.7% in both groups, and transplant-free survival was 91.3% versus 88.0%. pubmed.ncbi.nlm.nih.gov

Why Does It Matter?

TIPS sizing directly determines the balance between portal decompression and encephalopathy. These findings favour initial 7-mm deployment in carefully selected patients with smaller livers undergoing TIPS for secondary prevention. Generalizability is limited by the Chinese population, Fluency rather than Viatorr stents, and exclusion of portal-vein thrombosis and significant cardiopulmonary disease.

GastroAGI Takeaway

For variceal rebleeding prevention in cirrhosis with a small liver, 7-mm TIPS may provide the best haemodynamic compromise—substantially less encephalopathy with preserved shunt efficacy.