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Performance of ultrasound for detection of transjugular intrahepatic portosystemic shunt dysfunction: a meta-analysis

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Abstract

Purpose

Although ultrasound has been widely used to evaluate transjugular intrahepatic portosystemic shunts (TIPS) patency, several studies have reported conflicting data regarding its performance. Therefore, we aimed to evaluate performance of ultrasound for detection of TIPS dysfunction by performing a meta-analysis.

Methods

Literature search was performed for studies evaluating ultrasound for TIPS dysfunction, stenosis, and occlusion using PubMed, EMBASE, Scopus, and Cochrane Library through February 2019. Pooled sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under curve (AUC) of summary receiver-operating characteristic were calculated. Subgroup analyses were performed according to ultrasonographic criteria and type of stent.

Results

In total, 21 studies were evaluated. Pooled sensitivity, specificity, and LDOR of ultrasound for detection of TIPS dysfunction were 0.82 (0.67, 0.93), 0.58 (0.46, 0.70), and 1.77 (1.20, 2.35). Pooled sensitivity, specificity, and LDOR for TIPS stenosis were 0.80 (0.69, 0.90), 0.80 (0.69, 0.91), and 2.83 (1.88, 3.78). Pooled sensitivity, specificity, and LDOR for TIPS occlusion were 0.96 (0.92, 0.99), 1 (0.99, 1.00), and 6.28 (4.96, 7.60). AUCs of ultrasound for TIPS dysfunction, stenosis, and occlusion were 0.77, 0.86, and 0.95, respectively.

Conclusions

Although ultrasound had excellent performance for TIPS occlusion and acceptable performance for TIP stenosis, most studies utilized bare metal stent, and therefore, application to current practice is limited. Ultrasound for TIPS dysfunction in the setting of covered metal stent appeared to have acceptable sensitivity of 0.82, but limited specificity of 0.58 and low LDOR of 1.77. A new noninvasive tool is needed for detection of TIPS dysfunction in the era of covered metal stent.

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Acknowledgements

The authors would like to thank Roxanne Cox, MLS, McGoogan of the Library of Medicine, University of Nebraska Medical Center who provided advices and assisted in the literature search.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA

    Wuttiporn Manatsathit & Jane Suh

  2. Division of Gastroenterology, Louisiana State University Health Science Center, Shreveport, LA, USA

    Hrishikesh Samant

  3. Department of Biochemistry, Chiang Mai University, Chiang Mai, Thailand

    Panadeekarn Panjawatanan

  4. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    Annie Braseth & Noah Wiedel

  5. Department of Internal Medicine, Methodist Physicians Clinic, Council Bluffs, IA, USA

    Mohammad Esmadi

  6. Department of Family Medicine and Preventive Medicine, Prince of Songkhla University, Songkhla, Thailand

    Thammasin Ingviya

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  1. Wuttiporn Manatsathit
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Contributions

WM, HS, and PP participated in the study design. Data extraction was performed by WM and PP, while quality assessment was performed by ME and NW. TI performed statistical analyses. WM, JS, and AB participated in the manuscript preparation.

Corresponding author

Correspondence to Wuttiporn Manatsathit.

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This study was not supported by funding or grant. All authors have no financial disclosure.

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Electronic supplementary material

Below is the link to the electronic supplementary material.

261_2019_1981_MOESM1_ESM.tif

Supplementary material 1 (TIFF 1400 kb) Supplementary Fig. 1: Pooled sensitivity of studies evaluating performance of ultrasound for TIPS dysfunction

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Supplementary material 2 (TIFF 872 kb) Supplementary Fig. 2: Pooled specificity of studies evaluating performance of ultrasound for TIPS dysfunction

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Supplementary material 3 (TIFF 977 kb) Supplementary Fig. 3: LDOR of studies evaluating performance of ultrasound for TIPS dysfunction

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Supplementary material 4 (TIFF 7705 kb) Supplementary Fig. 4: Pooled sensitivity of studies evaluating performance of ultrasound for TIPS stenosis

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Supplementary material 5 (TIFF 7705 kb) Supplementary Fig. 5: Pooled specificity of studies evaluating performance of ultrasound for TIPS stenosis

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Supplementary material 6 (TIFF 7706 kb) Supplementary Fig. 6: LDOR of studies evaluating performance of ultrasound for TIPS stenosis

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Supplementary material 7 (TIFF 7791 kb) Supplementary Fig. 7: Pooled sensitivity of studies evaluating performance of ultrasound for TIPS occlusion

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Supplementary material 8 (TIFF 7790 kb) Supplementary Fig. 8: Pooled specificity of studies evaluating performance of ultrasound for TIPS occlusion

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Supplementary material 9 (TIFF 7791 kb) Supplementary Fig. 9: LDOR of studies evaluating performance of ultrasound for TIPS occlusion

Supplementary material 10 (DOCX 33 kb)

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Manatsathit, W., Samant, H., Panjawatanan, P. et al. Performance of ultrasound for detection of transjugular intrahepatic portosystemic shunt dysfunction: a meta-analysis. Abdom Radiol 44, 2392–2402 (2019). https://doi.org/10.1007/s00261-019-01981-w

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  • DOI: https://doi.org/10.1007/s00261-019-01981-w

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