Journal of Gastroenterology and Hepatology

Meta-Analysis

Preventing variceal rebleeding in cirrhotic patients with portal vein thrombosis: A systematic review and meta-analysis

Junyuan Zhu

Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China

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Yifu Xia,

Yifu Xia

Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China

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Xiao Liu,

Xiao Liu

Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China

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Chunqing Zhang,

Corresponding Author

Chunqing Zhang

[email protected]

orcid.org/0000-0001-8711-1579

Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China

Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China

Correspondence

Chunqing Zhang, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Wei Qi Road, Jinan 250021, Shandong Province, China.

Email: [email protected]

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Junyuan Zhu,

Junyuan Zhu

Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China

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Yifu Xia,

Yifu Xia

Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China

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Xiao Liu,

Xiao Liu

Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China

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Chunqing Zhang,

Corresponding Author

Chunqing Zhang

[email protected]

orcid.org/0000-0001-8711-1579

Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China

Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China

Correspondence

Chunqing Zhang, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jing Wu Wei Qi Road, Jinan 250021, Shandong Province, China.

Email: [email protected]

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First published: 17 January 2024

https://doi.org/10.1111/jgh.16489

Citations: 2

Declaration of conflict of interest: All authors declare no conflicts of interest.

Author Contributions: Study design: Junyuan Zhu and Chunqing Zhang; Literature search and data collection: Junyuan Zhu and Xiao Liu; Data analysis: Junyuan Zhu; Manuscript preparation: Junyuan Zhu, Yifu Xia and Chunqing Zhang. All authors read and approved the final manuscript.

Grant support: National Natural Science Foundation of China (Grant No. 81970533) and Natural Science Foundation of Shandong Province (Grant No. ZR2022ZD21).

Data availability statement: The data presented in this article will be made available by the corresponding author on reasonable request.

PROSPERO registration number: CRD42023439185.

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Abstract

Background and Aim

Preventing rebleeding is crucial, but the best prevention technique for patients with cirrhosis and portal vein thrombosis (PVT) remains debatable. Therefore, this systematic review and meta-analysis compared a transjugular intrahepatic portosystemic shunt (TIPS) with endoscopic therapy (ET) plus nonselective beta-blockers (NSBBs) for preventing variceal rebleeding in this patient population.

Methods

The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception until May 18, 2023. The studies were screened using predetermined criteria, relevant data were extracted, and pooled analyses were performed using the Reviewer Manager 5.4.1 software.

Results

We retrieved 1032 studies, of which 5 studies comprising a total of 272 patients were included. The postoperative variceal rebleeding rate was significantly lower in the TIPS group than in the ET + NSBBs group (odds ratio [OR] = 0.19, 95% confidence interval [CI] = 0.11–0.35, P < 0.05, I² = 0%), but the portal vein recanalization rate was higher (OR = 7.92, 95% CI = 3.04–20.67, P < 0.05, I² = 0%). The rates of hepatic encephalopathy (HE) and mortality did not differ between the groups.

Conclusions

Our results suggest that TIPS prevents variceal rebleeding without increasing the hepatic encephalopathy risk more effectively than ET plus NSBBs, but this benefit did not translate into improved survival. Thus, it may be preferable to ET plus NSBBs for preventing variceal rebleeding in patients with cirrhosis and PVT. However, more large-scale and multicenter randomized controlled trials involving other patient populations are required to verify the clinical efficacy of both these treatments and ensure generalizability.

Graphical Abstract

Supporting Information

Filename	Description
jgh16489-sup-0001-Table S1.docxWord 2007 document , 20.5 KB	Table S1. Quality of the retrospective cohort studies.
jgh16489-sup-0002-Figure S1.tifTIFF image, 724.7 KB	Figure S1. Study selection flow chart.
jgh16489-sup-0003-Figure S2.tifTIFF image, 482.4 KB	Figure S2. Risk of bias based on the quality of the randomized controlled trials.
jgh16489-sup-0004-Figure S3.tifTIFF image, 1,006.5 KB	Figure S3. The risk of bias summary based on the quality of the randomized controlled trials. (+): low risk of bias; (?): uncertain risk of bias; (−): high risk of bias.
jgh16489-sup-0005-Figure S4.tifTIFF image, 510.2 KB	Figure S4. Forest plot comparing the postoperative mortality rate between the TIPS and ET + NSBBs groups. CI: Confidence interval; ET + NSBBs: Endoscopic therapy plus nonselective beta-blockers; TIPS: transjugular intrahepatic portosystemic shunting.
jgh16489-sup-0006-Figure S5.tifTIFF image, 472.5 KB	Figure S5. Forest plot comparing postoperative mortality associated with liver failure between the TIPS and ET + NSBBs groups. CI: Confidence interval; ET + NSBBs: Endoscopic therapy plus nonselective beta-blockers; TIPS: transjugular intrahepatic portosystemic shunting.
jgh16489-sup-0007-Figure S6.tifTIFF image, 2 MB	Figure S6A. Forest plot comparing postoperative 1-year mortality rate between the TIPS and ET + NSBBs groups. CI: Confidence interval; ET + NSBBs: Endoscopic therapy plus nonselective beta-blockers; TIPS: transjugular intrahepatic portosystemic shunting. Figure S6B. Forest plot comparing postoperative 2-year mortality rate between the TIPS and ET + NSBBs groups. CI: Confidence interval; ET + NSBBs: Endoscopic therapy plus nonselective beta-blockers; TIPS: transjugular intrahepatic portosystemic shunting.
jgh16489-sup-0008-Figure S7.tifTIFF image, 130 KB	Figure S7. Funnel plot of the postoperative variceal rebleeding incidence. OR: Odds ratio; SE: Standard error.
jgh16489-sup-0009-Figure S8.tifTIFF image, 126.6 KB	Figure S8. Funnel plot of the postoperative mortality rate. OR: Odds ratio; SE: Standard error.

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Volume39, Issue4

April 2024

Pages 642-648