2023
AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review
Garcia-Tsao G, Abraldes J, Rich N, Wong V. AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review. Gastroenterology 2023, 166: 202-210. PMID: 37978969, DOI: 10.1053/j.gastro.2023.10.016.Peer-Reviewed Original ResearchConceptsSpontaneous bacterial peritonitisAcute kidney injuryLarge-volume paracentesisEffective arterial blood volumeVasoactive drugsVariceal hemorrhageArterial blood volumeHRS-AKIUncomplicated ascitesIntravenous albuminVolume statusPractice UpdateBlood volumeChronic liver failure grade 3Best practice advice statementsClinical Practice Updates CommitteeEnd-stage liver diseaseAGA Clinical Practice UpdateForms of AKIIntensive care unit monitoringAGA Governing BoardCombination of vasoconstrictorsInitial endoscopic hemostasisPatient's volume statusClinical Practice UpdateUpdate in the Treatment of the Complications of Cirrhosis
Abraldes J, Caraceni P, Ghabril M, Garcia-Tsao G. Update in the Treatment of the Complications of Cirrhosis. Clinical Gastroenterology And Hepatology 2023, 21: 2100-2109. PMID: 36972759, PMCID: PMC11097249, DOI: 10.1016/j.cgh.2023.03.019.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsTransjugular intrahepatic portosystemic shuntVariceal hemorrhageHepatic encephalopathyPre-emptive transjugular intrahepatic portosystemic shuntsAcute variceal hemorrhageCombination of terlipressinAcute kidney injuryComplications of cirrhosisSecond-line treatmentSignificant portal hypertensionFirst-line treatmentLeast common causePrognosis of patientsOrnithine L-aspartatePresence of varicesIntrahepatic portosystemic shuntStandard of careQuality of lifeCyanoacrylate injectionHepatorenal syndromeUncomplicated ascitesKidney injuryPortal hypertensionRefractory ascitesAlbumin use
2021
SACRED: Effect of simvastatin on hepatic decompensation and death in subjects with high-risk compensated cirrhosis: Statins and Cirrhosis: Reducing Events of Decompensation
Kaplan D, Mehta R, Garcia-Tsao G, Albrecht J, Aytaman A, Baffy G, Bajaj J, Hernaez R, Hunt K, Ioannou G, Johnson K, Kanwal F, Lee T, Monto A, Pandya P, Schaubel D, Taddei T. SACRED: Effect of simvastatin on hepatic decompensation and death in subjects with high-risk compensated cirrhosis: Statins and Cirrhosis: Reducing Events of Decompensation. Contemporary Clinical Trials 2021, 104: 106367. PMID: 33771685, PMCID: PMC8422958, DOI: 10.1016/j.cct.2021.106367.Peer-Reviewed Original ResearchConceptsHepatic decompensationPortal hypertensionEvents of decompensationHepatic decompensation eventsLiver-related deathSignificant portal hypertensionAcceptable safety profileProspective human studiesRole of statinsChronic liver diseaseClasses of medicationsPatient-reported outcomesDevelopment of decompensationEffect of simvastatinVA Medical CenterCompensated cirrhosisDecompensation eventsStatin therapyVariceal hemorrhageCirrhotic patientsStandard therapyVascular reactivityExert pleiotropic effectsLiver diseaseRetrospective studyVascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases
Northup PG, Garcia‐Pagan J, Garcia‐Tsao G, Intagliata NM, Superina RA, Roberts LN, Lisman T, Valla DC. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021, 73: 366-413. PMID: 33219529, DOI: 10.1002/hep.31646.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsDisease ManagementEsophageal and Gastric VaricesGastrointestinal HemorrhageHumansLiver CirrhosisPortal VeinRisk AssessmentSocieties, MedicalUnited StatesVaricose Veins
2020
Ordinal Outcomes Are Superior to Binary Outcomes for Designing and Evaluating Clinical Trials in Compensated Cirrhosis
D’Amico G, Abraldes JG, Rebora P, Valsecchi MG, Garcia‐Tsao G. Ordinal Outcomes Are Superior to Binary Outcomes for Designing and Evaluating Clinical Trials in Compensated Cirrhosis. Hepatology 2020, 72: 1029-1042. PMID: 31837238, PMCID: PMC11090179, DOI: 10.1002/hep.31070.Peer-Reviewed Original ResearchConceptsClinical trialsGrade 1Prevention of decompensationBaseline platelet countDevelopment of varicesSignificant outcome differencesLow baseline riskPrimary therapeutic targetCirrhosis decompensationCompensated cirrhosisInception cohortComposite endpointEsophageal varicesPlatelet countBinary outcomesDisease progressionSignificant treatment effectBaseline riskGrade 3Sample sizeOutcome differencesTherapeutic targetDecompensationGrade 2Larger sample size
2017
Stratifying risk in the prevention of recurrent variceal hemorrhage: Results of an individual patient meta‐analysis
Albillos A, Zamora J, Martínez J, Arroyo D, Ahmad I, De‐la‐Peña J, Garcia‐Pagán J, Lo G, Sarin S, Sharma B, Abraldes JG, Bosch J, Garcia‐Tsao G, Cooperation O. Stratifying risk in the prevention of recurrent variceal hemorrhage: Results of an individual patient meta‐analysis. Hepatology 2017, 66: 1219-1231. PMID: 28543862, PMCID: PMC5605404, DOI: 10.1002/hep.29267.Peer-Reviewed Original ResearchMeSH KeywordsAdrenergic beta-AntagonistsCombined Modality TherapyEsophageal and Gastric VaricesEsophagoscopyGastrointestinal HemorrhageHumansLiver CirrhosisRisk AssessmentSecondary PreventionConceptsChild B/CPrevious variceal bleedingCombination therapyVariceal bleedingCirrhosis severityChild APrognostic stageRecurrent variceal hemorrhageAdvanced liver failureEndoscopic variceal ligationOutcome of therapyVariceal hemorrhageLiver failureVariceal ligationLiver functionPatientsPatient careVaricealTherapyPatient dataMortalityTrialsCirrhosisBleedingProphylaxisValidating, deconstructing and refining Baveno criteria for ruling out high‐risk varices in patients with compensated cirrhosis
Jangouk P, Turco L, De Oliveira A, Schepis F, Villa E, Garcia‐Tsao G. Validating, deconstructing and refining Baveno criteria for ruling out high‐risk varices in patients with compensated cirrhosis. Liver International 2017, 37: 1177-1183. PMID: 28160373, PMCID: PMC5511584, DOI: 10.1111/liv.13379.Peer-Reviewed Original ResearchConceptsHigh-risk varicesNegative predictive valueBaveno VI criteriaLiver stiffnessBaveno criteriaPredictive valueItalian cohortPlatelet countNon-invasive criteriaCohort of patientsNumber of endoscopiesUnnecessary endoscopiesCompensated cirrhosisPrimary prophylaxisRetrospective studyUS cohortVariceal screeningTransient elastographyVaricesHigh riskLow prevalenceCirrhosisPatientsEndoscopyClinical diagnosis
2009
Pharmacological versus endoscopic therapy in the prevention of variceal hemorrhage: And the winner is…
Bosch J, Garcia‐Tsao G. Pharmacological versus endoscopic therapy in the prevention of variceal hemorrhage: And the winner is…. Hepatology 2009, 50: 674-677. PMID: 19714716, DOI: 10.1002/hep.23164.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2007
A pilot project examining the predicted preferences of patients and physicians in the primary prophylaxis of variceal hemorrhage
Longacre AV, Imaeda A, Garcia‐Tsao G, Fraenkel L. A pilot project examining the predicted preferences of patients and physicians in the primary prophylaxis of variceal hemorrhage. Hepatology 2007, 47: 169-176. PMID: 17935182, PMCID: PMC2674014, DOI: 10.1002/hep.21945.Peer-Reviewed Original ResearchConceptsEndoscopic variceal ligationProcedure-related bleedingVariceal hemorrhagePrimary prophylaxisPreferences of patientsRoute of administrationSexual dysfunctionFirst-line therapyShortness of breathIndividual patient preferencesUntreated patientsEsophageal varicesVariceal ligationPrimary preventionPatient preferencesRisk of fatigueTreatment preferencesProphylaxisSide effectsHemorrhagePatientsBleedingPhysiciansFuture guidelinesHypotensionPrevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis
Garcia‐Tsao G, Sanyal AJ, Grace ND, Carey W, Diseases T. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007, 46: 922-938. PMID: 17879356, DOI: 10.1002/hep.21907.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsHepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis
Ripoll C, Groszmann R, Garcia–Tsao G, Grace N, Burroughs A, Planas R, Escorsell A, Garcia–Pagan J, Makuch R, Patch D, Matloff DS, Bosch J, Group P. Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis. Gastroenterology 2007, 133: 481-488. PMID: 17681169, DOI: 10.1053/j.gastro.2007.05.024.Peer-Reviewed Original ResearchMeSH KeywordsAgedAscitesEsophageal and Gastric VaricesFemaleFollow-Up StudiesGastrointestinal HemorrhageHepatic EncephalopathyHumansHypertension, PortalKaplan-Meier EstimateLiver CirrhosisMaleMiddle AgedPortal PressurePredictive Value of TestsPrognosisProportional Hazards ModelsProspective StudiesRisk AssessmentRisk FactorsROC CurveSensitivity and SpecificitySeverity of Illness IndexTime FactorsConceptsHepatic venous pressure gradientVenous pressure gradientClinical decompensationPortal hypertensionMedian hepatic venous pressure gradientEnd-stage liver diseaseDiagnostic capacityBaseline laboratory testsPredictors of decompensationChild-Pugh scoreDevelopment of varicesMedical record reviewEnd of studyMedian followCompensated cirrhosisLiver transplantationLiver diseaseRecord reviewStudy terminationDecompensationPatientsCirrhosisMultivariate analysisVaricesHypertension
2002
Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis
Ginès P, Uriz J, Calahorra B, Garcia–Tsao G, Kamath PS, Del Arbol LR, Planas R, Bosch J, Arroyo V, Rodés J, Cirrhosis F. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology 2002, 123: 1839-1847. PMID: 12454841, DOI: 10.1053/gast.2002.37073.Peer-Reviewed Original ResearchMeSH KeywordsAscitesBacterial InfectionsFemaleGastrointestinal HemorrhageHepatic EncephalopathyHormonesHumansInjections, IntravenousKidneyLiverLiver CirrhosisMaleMiddle AgedParacentesisPeritonitisPortasystemic Shunt, Transjugular IntrahepaticRetreatmentSerum AlbuminSeverity of Illness IndexSurvival AnalysisConceptsTransjugular intrahepatic portosystemic shuntRefractory ascitesParacentesis groupLiver transplantationHepatorenal syndromeTIPS groupTransjugular intrahepatic portosystemic shuntingBlood urea nitrogen levelsChild-Pugh scoreComplications of cirrhosisIntrahepatic portosystemic shuntRecurrence of ascitesSevere hepatic encephalopathyUrea nitrogen levelsIntravenous albuminPrimary endpointSecondary endpointsHepatic encephalopathyPortosystemic shuntingPortosystemic shuntAscites recurrenceParacentesisHealthcare costsAscitesProbability of survival
2001
Propranolol for the prevention of first esophageal variceal hemorrhage: A lifetime commitment?
Abraczinskas D, Ookubo R, Grace N, Groszmann R, Bosch J, Garcia‐Tsao G, Richardson C, Matloff D, Rodés J, Conn H. Propranolol for the prevention of first esophageal variceal hemorrhage: A lifetime commitment? Hepatology 2001, 34: 1096-1102. PMID: 11731997, DOI: 10.1053/jhep.2001.29305.Peer-Reviewed Original ResearchConceptsVariceal hemorrhageBeta blockersVariceal bleedingPrimary preventionFirst esophageal variceal hemorrhageWithdrawal of propranololOutcomes of patientsPlacebo-controlled trialEsophageal variceal hemorrhageGroup of patientsOriginal study populationUntreated populationBlocker therapyIndefinite administrationPlacebo groupPortal hypertensionProphylactic therapyProspective studyCumulative survivalProtective effectStudy populationHemorrhagePatientsPropranololBlockersCurrent management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis
Garcia–Tsao G. Current management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology 2001, 120: 726-748. PMID: 11179247, DOI: 10.1053/gast.2001.22580.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsAscitesBacterial InfectionsEsophageal and Gastric VaricesGastrointestinal HemorrhageHepatorenal SyndromeHumansHypertension, PortalLiver CirrhosisPeritonitisRecurrence
1998
Portal hypertension and variceal bleeding: An AASLD single topic symposium
Grace N, Groszmann R, Garcia‐Tsao G, Burroughs A, Pagliaro L, Makuch R, Bosch J, Stiegmann G, Henderson J, de Franchis R, Wagner J, Conn H, Rodes J. Portal hypertension and variceal bleeding: An AASLD single topic symposium. Hepatology 1998, 28: 868-880. PMID: 9731585, DOI: 10.1002/hep.510280339.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
1996
Gastroesophageal varices hemorrhage: non-surgical treatment.
García-Tsao G. Gastroesophageal varices hemorrhage: non-surgical treatment. Revista De Gastroenterología De México 1996, 61: s87-9. PMID: 9102789.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsEndoscopyEsophageal and Gastric VaricesGastrointestinal HemorrhageHumansPortasystemic Shunt, Transjugular IntrahepaticRecurrence
1995
Variceal Hemorrhage
Navarro V, Garcia-Tsao G. Variceal Hemorrhage. Critical Care Clinics 1995, 11: 391-414. PMID: 7788538, DOI: 10.1016/s0749-0704(18)30073-3.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsVariceal bleedingVariceal hemorrhageFirst variceal bleedingHigh recurrence ratePortal hypertensionBalloon tamponadePharmacologic therapyPortal pressureShunt surgeryActive hemorrhageRecurrence rateBlood flowTherapeutic avenuesHigh mortalityHemorrhageBleedingPreventionHypertensionTamponadeSclerotherapyComplicationsSurgeryRelative effectivenessTherapyMortality
1992
Elective treatment of bleeding varices with the Sugiura operation over 10 years
Orozco H, Mercado M, Takahashi T, Hernández-Ortiz J, Capellán^S J, Garcia-Tsao G. Elective treatment of bleeding varices with the Sugiura operation over 10 years. The American Journal Of Surgery 1992, 163: 585-589. PMID: 1595838, DOI: 10.1016/0002-9610(92)90562-6.Peer-Reviewed Original ResearchConceptsSugiura operationOperative mortality rateEarly postoperative periodDevascularization operationEncephalopathy ratesLow rebleedingPortal hypertensionPostoperative periodElective treatmentTherapeutic armamentariumOperative procedureEsophageal fistulaMortality ratePatientsRebleedingHypertensionVaricesFistulaTransectionGroupHepatopathyArmamentariumShunt
1991
The Sugiura procedure for patients with hemorrhagic portal hypertension secondary to extrahepatic portal vein thrombosis.
Orozco H, Takahashi T, Mercado M, Garcia-Tsao G, Hernandez-Ortiz J. The Sugiura procedure for patients with hemorrhagic portal hypertension secondary to extrahepatic portal vein thrombosis. Journal Of The American College Of Surgeons 1991, 173: 45-8. PMID: 1866670.Peer-Reviewed Original ResearchConceptsHemorrhagic portal hypertensionPortal vein thrombosisSugiura procedurePortal hypertensionVein thrombosisActuarial survival rateAssociated hepatic diseaseHistory of omphalitisAntithrombin III deficiencyHistory of pancreatitisProtein C deficiencyOperative deathsMale patientsMean ageSurgical stageHepatic diseaseIII deficiencyPatientsSurvival rateC deficiencyHypertensionThrombosisEPVTDeficiencyLong termPropranolol in the prevention of the first hemorrhage from esophagogastric varices: A multicenter, randomized clinical trial
Conn H, Grace N, Bosch J, Groszmann R, Rodés J, Wright S, Matloff D, Garcia‐Tsao G, Fisher R, Navasa M, Drewniak S, Atterbury C, Bordas J, Lerner E, Bramante C. Propranolol in the prevention of the first hemorrhage from esophagogastric varices: A multicenter, randomized clinical trial. Hepatology 1991, 13: 902-912. PMID: 2029994, DOI: 10.1002/hep.1840130517.Peer-Reviewed Original ResearchConceptsHepatic venous pressure gradientVenous pressure gradientPlacebo groupPropranolol groupEsophageal varicesVariceal hemorrhageChild class AEffectiveness of propranololFirst variceal hemorrhageInitial variceal hemorrhageCessation of therapyPortal hypertensive gastropathyChild class BDoses of propranololLarge esophageal varicesHepatic vein cathetersBeats/minClass BPlacebo patientsPropranolol patientsAlcoholic cirrhosisHypertensive gastropathyMean followMedian doseLarge varices