Standard Therapy and TIPS for Moderate to High-risk Esophageal and Gastric Variceal Bleeding

This trial is comparing two strategies for preventing bleeding from enlarged veins in the esophagus or stomach (varices) in people with liver cirrhosis and moderately elevated pressure in the liver's blood supply. One approach uses standard medications (beta blockers); the other adds a procedure called TIPS (a small tube inserted in the liver to reduce pressure). **You may be eligible if...** - You are between 18 and 80 years old - You have confirmed liver cirrhosis caused by viral hepatitis or alcohol use - You have moderate-to-severe esophageal or stomach varices with at least one prior bleeding episode - Your liver pressure (HVPG) is between 16 and 20 mmHg - Your liver function is at Child-Turcotte-Pugh grade B or C (but less than 14 points) - You have a life expectancy of more than 1 year **You may NOT be eligible if...** - Your cirrhosis is from non-viral, non-alcohol causes - You cannot take beta blockers (e.g., you have asthma, serious heart block, or severe heart failure) - Your bilirubin is very high (>85.5 µmol/L) - You have liver cancer or severe organ dysfunction - You have uncontrolled fluid buildup or kidney-liver syndrome - You are pregnant or planning to become pregnant Talk to your doctor to see if this trial is right for you.