Reply

We thank Kumar and colleagues for their interest in our new algorithm for risk-stratification in candidates to secondary prophylaxis of variceal bleeding. In this algorithm, patients that bleed without other manifestations of hepatic decompensation are classified as low-risk without measuring the hepatic venous pressure gradient (HVPG). Using our new algorithm, a large number of invasive and costly HVPG measurements can be saved. More importantly, the number of high-risk patients who did not rebleed during follow-up (the "grey zone") decreased from 43% to 23%, demonstrating great accuracy in selecting high-risk patients.