Hermie L, et al. - Researchers conducted this cohort study to assess the outcome of early transjugular portosystemic shunt (TIPS) treatment in subjects with a trial-compatible high-risk variceal bleeding, as well as disclosed other predictors of early mortality. They included 32 patients with Child-Pugh C score less than 14 or Child-Pugh B plus active bleeding at endoscopy, admitted for early-TIPS treatment (<72 h). In a selected patient group with a low model for end-stage liver disease (MELD) score, they confirmed the excellent survival outcomes of early-TIPS treatment for acute variceal bleeding. According to the findings obtained, poor survival in hemodynamically unstable patients with high MELD scores (≥19) challenges the guidelines that patients with Child–Pugh class C cirrhosis or Child–Pugh class B with active bleeding on endoscopy ought to deliberately receive preemptive TIPS treatment after endoscopic haemostasis.