Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: A meta-analysis
Xingshun Qi
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Department of Gastroenterology, No. 463 Hospital of Chinese PLA, Shenyang, China
These authors contributed equally to this study.Search for more papers by this authorLei Liu
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
These authors contributed equally to this study.Search for more papers by this authorMing Bai
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
These authors contributed equally to this study.Search for more papers by this authorHui Chen
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorJuan Wang
Department of Gastroenterology, No. 463 Hospital of Chinese PLA, Shenyang, China
Search for more papers by this authorZhiping Yang
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorCorresponding Author
Guohong Han
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Correspondence
Professor Daiming Fan, Guohong Han, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 Changle West Road, Xi'an 710032, China. Email: [email protected] (DF); [email protected] (GH)
Search for more papers by this authorCorresponding Author
Daiming Fan
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Correspondence
Professor Daiming Fan, Guohong Han, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 Changle West Road, Xi'an 710032, China. Email: [email protected] (DF); [email protected] (GH)
Search for more papers by this authorXingshun Qi
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Department of Gastroenterology, No. 463 Hospital of Chinese PLA, Shenyang, China
These authors contributed equally to this study.Search for more papers by this authorLei Liu
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
These authors contributed equally to this study.Search for more papers by this authorMing Bai
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
These authors contributed equally to this study.Search for more papers by this authorHui Chen
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorJuan Wang
Department of Gastroenterology, No. 463 Hospital of Chinese PLA, Shenyang, China
Search for more papers by this authorZhiping Yang
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Search for more papers by this authorCorresponding Author
Guohong Han
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Correspondence
Professor Daiming Fan, Guohong Han, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 Changle West Road, Xi'an 710032, China. Email: [email protected] (DF); [email protected] (GH)
Search for more papers by this authorCorresponding Author
Daiming Fan
Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
Correspondence
Professor Daiming Fan, Guohong Han, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 27 Changle West Road, Xi'an 710032, China. Email: [email protected] (DF); [email protected] (GH)
Search for more papers by this authorAbstract
Background and Aim
Transjugular intrahepatic portosystemic shunt (TIPS) is the mainstay treatment option for the complications of portal hypertension. Whether or not variceal embolization should be performed during TIPS procedures remains controversial. A meta-analysis to compare the incidence of shunt dysfunction, variceal rebleeding, encephalopathy, and death between patients treated with TIPS alone and those treated with TIPS combined with variceal embolization was conducted.
Methods
All relevant studies were searched via PubMed, EMBASE, and Cochrane Library databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled. Heterogeneity among studies and publication bias were assessed.
Results
Six articles were included in our study. Type of stents was covered (n = 2), bare (n = 2), mixed (n = 1), and unknown (n = 1). Varices were angiographically embolized by coils in six studies. Additional liquids agents were employed in three studies. Compared with TIPS alone group, TIPS combined with variceal embolization group had a significantly lower incidence of variceal rebleeding (OR 2.02, 95% CI 1.29–3.17, P = 0.002), but a similar incidence of shunt dysfunction (OR 1.26, 95% CI 0.76–2.08, P = 0.38), encephalopathy (OR 0.81, 95% CI 0.46–1.43, P = 0.47), and death (OR 0.90, 95% CI 0.55–1.47, P = 0.68). Neither any significant heterogeneity nor proof of publication bias among studies was found in all meta-analyses.
Conclusions
Adjunctive variceal embolization during TIPS procedures might be beneficial in the prevention of variceal rebleeding. However, given the heterogeneity of type of stents, embolic agents, type of varices, and indications of variceal embolization among studies, additional well-designed randomized, controlled trials with larger sample size and use of covered stents should be warranted to confirm these findings.
Supporting Information
| Filename | Description |
|---|---|
| jgh12391-sup-0001-si.JPG227.4 KB |
Figure S1 Funnel plot to explore the publication bias in the meta-analysis regarding the incidence of shunt dysfunction. |
| jgh12391-sup-0002-si.JPG586.6 KB |
Figure S2 Forest plots of subgroup meta-analyses comparing the incidence of shunt dysfunction between TIPS alone group and TIPS combined with variceal embolization group according to the type of stents. |
| jgh12391-sup-0003-si.JPG581.5 KB |
Figure S3 Forest plots of subgroup meta-analyses comparing the incidence of shunt dysfunction between TIPS alone group and TIPS combined with variceal embolization group according to the quality of studies. |
| jgh12391-sup-0004-si.JPG240.1 KB |
Figure S4 Funnel plot to explore the publication bias in the meta-analysis regarding the incidence of variceal rebleeding. |
| jgh12391-sup-0005-si.JPG230.8 KB |
Figure S5 Funnel plot to explore the publication bias in the meta-analysis regarding the incidence of encephalopathy. |
| jgh12391-sup-0006-si.JPG581 KB |
Figure S6 Forest plots of subgroup meta-analyses comparing the incidence of encephalopathy between TIPS alone group and TIPS combined with variceal embolization group according to the type of stents. |
| jgh12391-sup-0007-si.JPG550.1 KB |
Figure S7 Forest plots of subgroup meta-analyses comparing the incidence of encephalopathy between TIPS alone group and TIPS combined with variceal embolization group according to the quality of studies. |
| jgh12391-sup-0008-si.JPG228.9 KB |
Figure S8 Funnel plot to explore the publication bias in the meta-analysis regarding the mortality. |
| jgh12391-sup-0009-si.JPG613.2 KB |
Figure S9 Forest plots of subgroup meta-analyses comparing the mortality between TIPS alone group and TIPS combined with variceal embolization group according to the type of stents. |
| jgh12391-sup-0010-si.JPG603.7 KB |
Figure S10 Forest plots of subgroup meta-analyses comparing the mortality between TIPS alone group and TIPS combined with variceal embolization group according to the quality of studies. |
| jgh12391-sup-0011-si.doc35 KB |
Table S1 Detailed information regarding embolization techniques and embolic agents. |
| jgh12391-sup-0012-si.doc35 KB |
Table S2 Detailed information regarding classification of varices. |
| jgh12391-sup-0013-si.doc34.5 KB |
Table S3 Detailed information regarding indications of variceal embolization. |
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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