title: EVS vs TIPS shunt for gastric variceal bleeding in patients with cirrhosis: A meta-analysis.
abstract: OBJECTIVE
  To evaluate the clinical effects of transjugular intrahepatic portosystemic shunt (TIPS) vs endoscopic variceal sclerotherapy (EVS) in the management of gastric variceal (GV) bleeding in terms of variceal rebleeding, hepatic encephalopathy (HE), and survival by meta-analysis.
  
  
  METHODS
  Medline, Embase, and CNKI were searched. Studies compared TIPS with EVS in treating GV bleeding were identified and included according to our predefined inclusion criteria. Data were extracted independently by two of our authors. Studies with prospective randomized design were considered to be of high quality. Hazard ratios (HRs) or odd ratios (ORs) were calculated using a fixed-effects model when there was no inter-trial heterogeneity. Oppositely, a random-effects model was employed.
  
  
  RESULTS
  Three studies with 220 patients who had at least one episode of GV bleeding were included in the present meta-analysis. The proportions of patients with viral cirrhosis and alcoholic cirrhosis were 39% (range 0%-78%) and 36% (range 12% to 41%), respectively. The pooled incidence of variceal rebleeding in the TIPS group was significantly lower than that in the EVS group (HR = 0.3, 0.35, 95%CI: 0.17-0.71, P = 0.004). However, the risk of the development of any degree of HE was significantly increased in the TIPS group (OR = 15.97, 95%CI: 3.61-70.68). The pooled HR of survival was 1.26 (95%CI: 0.76-2.09, P = 0.36). No inter-trial heterogeneity was observed among these analyses.
  
  
  CONCLUSIONS
  The improved effect of TIPS in the prevention of GV rebleeding is associated with an increased risk of HE. There is no survival difference between the TIPS and EVS groups. Further studies are needed to evaluate the survival benefit of TIPS in cirrhotic patients with GV bleeding.
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Dai-Ming Fan, Guo-Hong Han, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Dai-Ming Fan, Guo-Hong Han, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Xing-Shun
authors.initials: XS
authors.lastname: Qi
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Dai-Ming Fan, Guo-Hong Han, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Zhi-Ping
authors.initials: ZP
authors.lastname: Yang
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Dai-Ming Fan, Guo-Hong Han, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Kai-Chun
authors.initials: KC
authors.lastname: Wu
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Dai-Ming Fan, Guo-Hong Han, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Dai-Ming
authors.initials: DM
authors.lastname: Fan
authors.affiliation: Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Dai-Ming Fan, Guo-Hong Han, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China.
authors.forename: Guo-Hong
authors.initials: GH
authors.lastname: Han
keywords: Cirrhosis; Endoscopic variceal sclerotherapy; Gastric variceal bleeding; Hepatic encephalopathy; Transjugular intrahepatic portosystemic shunt