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Comparative outcome of transjugular intrahepatic portosystemic shunt with or without variceal obliteration: a systematic review and meta-analysis

  • Interventional Radiology
  • Published:
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Abstract

Background

Transjugular intrahepatic portosystemic shunt (TIPS) has been used for the secondary prevention of variceal bleeding. TIPS can be combined with variceal embolization (TIPS-VO), but its benefit remains controversial. The present systematic review and meta-analysis were conducted to compare the incidence of rebleeding, adverse events, and mortality among patients with TIPS alone and with TIPS-VO.

Methods

A literature search from January 2000 to June 2022 was done for studies comparing the outcome of patients undergoing TIPS alone or TIPS-VO. A subgroup analysis was conducted for patients undergoing TIPS with covered stents.

Results

A total of 11 studies with data from 1044 patients were included. The incidence of rebleeding was significantly higher in the TIPS alone group in both overall population OR 2.01 (1.42–2.83) and the subgroup (OR 1.92, 95% CI 1.21–3.04). There was no difference between the two groups concerning the risk of hepatic encephalopathy (OR 1.15, 95% CI 0.83–1.59), procedural adverse events (OR 0.86, 95% CI 0.54–1.39), shunt dysfunction (OR 1.20, 95% CI 0.82–1.75), overall mortality (OR 1.03, 95% CI 0.73–1.46), and mortality due to variceal rebleeding (OR 1.58, 95% CI 0.44–5.64). There was no significant heterogeneity or publication bias among the included studies. The certainty of evidence remains low for all the outcome expect for variceal rebleeding.

Conclusion

The present meta-analysis provides a moderate-quality evidence for the benefit of TIPS-VO in reducing the incidence of rebleeding. However, the decision for combining variceal embolization with TIPS should be made on a case-to-case basis.

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Authors and Affiliations

  1. Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India

    Suprabhat Giri

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India

    Ranjan Kumar Patel & Taraprasad Tripathy

  3. Department of Gastroenterology, KM Cherian Institute of Medical Sciences, Kallissery, India

    Jijo Varghese

  4. Department of Gastroenterology, PACE Hospital, Hyderabad, India

    Dhiraj Agarwal

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  1. Suprabhat Giri
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  5. Taraprasad Tripathy
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Contributions

Conceptualization: SG, TT; Data curation: SG, RP, TT; Formal analysis: SG, RP, DA, TT; Funding acquisition: N/A; Investigation: SG, JV; Methodology: SG, RP, JV, TT; Project administration: SG, tt; Resources: SG, DA, JV; Software: SG; Supervision; SS, TT; Validation: SG, TT; Visualization: SG; Roles/Writing—original draft: SG, RP, DA, TT; Writing—review & editing: SG, RP, DA, JV, TT.

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Correspondence to Taraprasad Tripathy.

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Giri, S., Patel, R.K., Varghese, J. et al. Comparative outcome of transjugular intrahepatic portosystemic shunt with or without variceal obliteration: a systematic review and meta-analysis. Abdom Radiol 48, 1429–1437 (2023). https://doi.org/10.1007/s00261-023-03843-y

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  • DOI: https://doi.org/10.1007/s00261-023-03843-y

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