Dissegna D, et al. - Predictors of hepatic encephalopathy (HE) development and cumulative transplant-free survival after transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with cirrhosis complicated by refractory ascites and major gastroesophageal bleeding were investigated. Researchers examined 63 cirrhotic patients who underwent TIPS positioning as a secondary prophylaxis of major upper gastroesophageal bleeding (N=30) or to control refractory ascites (N=33). Outcomes suggest that for patients with cirrhosis and severe complications of portal hypertension that are not manageable with standard treatments, TIPS insertion could be viewed as a safe and effective treatment option. Interestingly, on confirming this in future studies, the addition of the history of spontaneous bacterial peritonitis pre-TIPS could be made to the model for end-stage liver disease score as a strong baseline predictor of post-TIPS mortality.