We recently read with interest the study by Tripathi and colleagues1 investigating the outcome of TIPS in patients with gastric (GV) compared to oesophageal varices (OV). This study confirmed the previous finding of lower mean portosystemic pressure gradient (PPG) in patients with GV bleeding relative to those with a history of OV bleeding.2 Indeed in this study 35% (14/40) of GV patients compared to only 8% (20/2320 of OV patients had a PPG <12 mm Hg. The group of patients who bleed at PPG <12 mm Hg (group 1) is particularly intriguing. As mentioned by the authors, low PPG in GV patients has been shown to correlate with the presence and size of a spontaneous gastrorenal shunt (GRS) which is present in up to 85% of GV patients but present in only about 20% of OV patients.3 Previously, Sanyal et al found that 50% (6/12) of patients who underwent TIPS for prevention of GV re-bleeding failed to decompress the varices as documented by endoscopy. 4/6 of these patients had a large GRS and a PPG <12 …