06109343

October 28, 2023, 22:34

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TO THE EDITOR We are watching with interest the new literature published discussing the topic of hepatic recompensation according to Baveno VII criteria [1]. We believe it is a promising topic for patients with decompensated liver cirrhosis as it was previously thought that reaching the stage of decompensation in liver cirrhosis is a point of no return. This topic opens a new hope for patients with decompensated liver cirrhosis and would affect their clinical outcome if the appropriate therapeutic measures were taken. The Baveno VII concept of hepatic recompensation focuses on the clearance of the etiological factor of the chronic liver disease and proof of clinical and biochemical improvement of the patient’s conditions. We read the interesting manuscript of Gao L et al [2], who presented a retrospective analysis on 64 patients who received TIPS for variceal bleeding or refractory ascites. It was interesting that one third of the patient population achieved hepatic recompensation as per Baveno VII criteria. The concept of Baveno VII is novel and we still need more and more studies to accurately define the rate of recompensation under its criteria. Most of the previous studies focused on etiological clearance before measuring recompensation. It is interesting that this study adds a therapeutic intervention for portal hypertension in addition to etiological clearance. However, Baveno VII criteria put a condition of removal of the aetiology of liver cirrhosis. It was mentioned in the study that all patients received necessary medication or lifestyle interventions for treating their respective causes according to the Guidelines of the European Association for the Study of the Liver Disease and that these interventions had been aimed at achieving the removal/suppression of the primary cause of cirrhosis. It is not mentioned in the study what primary disease did the study cohort have, in addition to whether they achieved etiological clearance or only suppression. In case there was only suppression instead of clearance of the primary disease, then one factor of Baveno VII criteria is not fulfilled. This point was highlighted in the study limitations’ part. We suggest that therapeutic interventions as TIPS would be considered in criteria of recompensation independent of clearance of the primary disease in future recompensation definitions in case it could not be achieved or sub-optimally achieved, as in many cases with non-alcohol and non-viral etiologies. Again, more prospective, multicenter studies will add to the growing body of evidence discussing this topic. They could involve differential cohorts of patients with different underlying etiologies. They could also discuss the natural history of hepatic recompensation, modifying factors, potential noninvasive biomarkers, and molecular mechanisms of the disease regression [3]. Double blinded studies will pose an ethical challenge as giving no intervention to clear the etiology for decompensated cases will deprive those patients in such an advanced condition from a potential of their disease improvement. REFERENCES: 1 R. de Franchis, J. Bosch, G. Garcia Tsao, T. Reiberger, C. Ripoll, J.G. Abraldes, et al. Baveno VII - renewing consensus in portal hypertension J Hepatol (2021), p. 0 2 Gao L, Li MB, Li JY, Liu Y, Ren C, Feng DP. Impressive recompensation in transjugular intrahepatic portosystemic shunt-treated individuals with complications of decompensated cirrhosis based on Baveno VII criteria. World J Gastroenterol 2023; 29(38): 5383-5394 [DOI: 10.3748/wjg.v29.i38.5383] 3 Reiberger T, Hofer BS. The Baveno VII concept of cirrhosis recompensation. Dig Liver Dis. 2023 Apr;55(4):431-441. doi: 10.1016/j.dld.2022.12.014. Epub 2023 Jan 14. PMID: 36646527.

First, thank you very much for your professional comments on the article published in World Journal of Gastroenterology. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Gastroenterology at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.

07482811

October 22, 2023, 01:56

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This is a retrospective study focused on recompensation after TIPS procedure. The authors confirmed TIPS could be a theatment for recompensation of patients with cirrhosis according to Baveno VII. This is an interesting topic and needs further investigating. However, the sample size seemed small and the conclusions need to be verified in larger cohort. In the article, authors proposed that lower PPG is an independent factor for recompensation of cirrhotic patients. I'm afraid that although lower PPG can reduce complications on portal hypertension, it helps less on liver function. Thus, there might be other factors that can influence the recompensation of TIPS treatment.

First, thank you very much for your professional comments on the article published in World Journal of Gastroenterology. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Gastroenterology at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.