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[35] When comparing conventional endoscopic "blind" cyanoacrylate injection to EUS-guided cyanoacrylate injection for gastric varices, Bick et al found that EUS-guided injection decreased (mainly early) rebleeding rate, despite injecting more varices with less glue in the EUS group. Keywords: endoscopy; hepatology; endoscopic ultrasound; portal hypertension; varices EN endoscopy hepatology endoscopic ultrasound portal hypertension varices 176 188 13 07/18/23 20230501 NES 230501 Lay Summary Upper gastrointestinal endoscopy and ultrasound endoscopy are important tools in the diagnosis and treatment of liver disease. [5][6] Esophageal VNT, as defined by the Baveno working group, are medium-to-large varices, I or i varices with the presence of red spots or red wale signs, I or i varices in patients with Child C cirrhosis. Sarin's classification for gastric varices Gastroesophageal varices type 1 (GOV 1)Continuation of esophageal varices into the lesser curvature Gastroesophageal varices type 2 (GOV 2)Esophageal varices extending to the fundus Isolated gastric varices type 1 (IGV 1)Fundal varices in absence of esophageal varices Isolated gastric varices type 2 (IGV 2)Varices in the stomach outside the cardiofundal region or in the first part of the duodenum ht 1 Source: Adapted from Philips CA, Sahney A. Oesophageal and gastric varices: historical aspects, classification and grading: everything in one place. [Extracted from the article]

The benefits of TIPS insertion for patients with ACLF outweigh the disadvantages, and TIPS should be considered as an option for variceal bleeding, potentially reducing the mortality rate of patients with ACLF and bleeding. [10] Gastrointestinal hemorrhage contributes mainly to the clinical course of UDC and despite the standard of care, timely control of bleeding, prevention of ACLF, and rebleeding and mortality are vital. Prevention and Treatment of Bleeding as Precipitant The management of bleeding as a precipitating event for AD or ACLF consists not only of bleeding control but also of prevention of ACLF (see above) and secondary prophylaxis. Keywords: TIPS; acute-on-chronic liver failure; variceal bleeding; systemic inflammation EN TIPS acute-on-chronic liver failure variceal bleeding systemic inflammation 189 205 17 07/18/23 20230501 NES 230501 Cirrhosis is the end stage of liver fibrosis following chronic and sustained injury to the liver leading to parenchymal extinction, regenerative nodules, and the arise of completely vascularized fibrotic septa responsible for portosystemic shunting. [Extracted from the article]