Transjugular intrahepatic portosystemic shunt versus endoscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients: meta-analysis update.
OBJECTIVE
The aim of this study was to determine through meta-analysis the effects of transjugular intrahepatic portosystemic shunt (TIPS) for the reduction of variceal rebleeding (VRB).


BACKGROUND
Variceal bleeding is one of the most frequent and severe complications of chronic liver disease. Although prophylactic use of TIPS for the reduction of VRB has been evaluated, the discrepancy about TIPS's beneficial effect on cirrhotic patients still exists.


METHODS
We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trials (RCTs) of TIPS versus endoscopic therapy in the prevention of VRB including 12 RCTs conducted in 7 different countries.


RESULTS
Most RCTs reviewed were of high quality. The updated meta-analysis showed that the decreased incidence of VRB [odds ratio (OR)=0.32, 95% confidence interval (CI) (0.24-0.43), P<0.00001], deaths due to rebleeding [OR=0.35, 95% CI (0.18-0.67), P=0.002], the increased rate of posttreatment encephalopathy [OR=2.21, 95% CI (1.61-3.03), P<0.00001] were correlated with TIPS, whereas the hospitalization days [weighted mean difference=-0.21, 95% CI (-3.50 to 3.08), P=0.90] and deaths due to all causes [OR=1.17, 95% CI (0.85-1.61), P=0.33] returned negative results in 2 groups.


CONCLUSIONS
TIPS is currently the first choice to prevent rebleeding except that TIPS is worse than endoscopic therapy for encephalopathy. An exploration of new approaches out of above complications will be of considerable clinical significance and be a challenge to clinicians.
Zheng
Minghua
M
Department of Infection and Liver Diseases The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.
Chen
Yongping
Y
Bai
Jianling
J
Zeng
Qiqiang
Q
You
Jie
J
Jin
Rong
R
Zhou
Xiaosa
X
Shen
Hong
H
Zheng
Yi
Y
Du
Zhou
Z
D016145:Endoscopy, Digestive System / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D055502:Secondary Prevention; D016896:Treatment Outcome