title: Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: a meta-analysis.
abstract: OBJECTIVE
  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.
authors.affiliation: Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China; Department of Gastroenterology, No. 463 Hospital of Chinese PLA, Shenyang, China.
authors.forename: Xingshun
authors.initials: X
authors.lastname: Qi
authors.forename: Lei
authors.initials: L
authors.lastname: Liu
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Juan
authors.initials: J
authors.lastname: Wang
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Yang
authors.forename: Guohong
authors.initials: G
authors.lastname: Han
authors.forename: Daiming
authors.initials: D
authors.lastname: Fan
mesh_terms: D016206:Databases, Bibliographic; D004621:Embolization, Therapeutic / Q000379:methods; D006470:Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000628:therapy*; D015994:Incidence; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D055502:Secondary Prevention; D014648:Varicose Veins / Q000453:epidemiology / Q000517:prevention & control*
keywords: meta-analysis; transjugular intrahepatic portosystemic shunt; variceal bleeding; variceal embolization