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Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: A meta‐analysis
Author(s) -
Qi Xingshun,
Liu Lei,
Bai Ming,
Chen Hui,
Wang Juan,
Yang Zhiping,
Han Guohong,
Fan Daiming
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12391
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , hepatic encephalopathy , embolization , odds ratio , gastroenterology , meta analysis , portal hypertension , confidence interval , varices , incidence (geometry) , cirrhosis , surgery , radiology , physics , optics
Abstract 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 C ochrane L ibrary 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.