title: Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis.
abstract: OBJECTIVE
  To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in refractory hepatic hydrothorax (RHH) in a systematic review and cumulative meta-analysis.
  
  
  METHODS
  A comprehensive literature search was conducted on MEDLINE, EMBASE, and PubMed covering the period from January 1970 to August 2014. Two authors independently selected and abstracted data from eligible studies. Data were summarized using a random-effects model. Heterogeneity was assessed using the I (2) test.
  
  
  RESULTS
  Six studies involving a total of 198 patients were included in the analysis. The mean (SD) age of patients was 56 (1.8) years. Most patients (56.9%) had Child-Turcott-Pugh class C disease. The mean duration of follow-up was 10 mo (range, 5.7-16 mo). Response to TIPSS was complete in 55.8% (95%CI: 44.7%-66.9%), partial in 17.6% (95%CI: 10.9%-24.2%), and absent in 21.2% (95%CI: 14.2%-28.3%). The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mmHg. The incidence of TIPSS-related encephalopathy was 11.7% (95%CI: 6.3%-17.2%), and the 45-d mortality was 17.7% (95%CI: 11.34%-24.13%).
  
  
  CONCLUSIONS
  TIPSS is associated with a clinically relevant response in RHH. TIPSS should be considered early in these patients, given its poor prognosis.
authors.affiliation: Ivo C Ditah, Badr F Al Bawardy, Behnam Saberi, Patrick S Kamath, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Ivo C
authors.initials: IC
authors.lastname: Ditah
authors.affiliation: Ivo C Ditah, Badr F Al Bawardy, Behnam Saberi, Patrick S Kamath, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Badr F
authors.initials: BF
authors.lastname: Al Bawardy
authors.affiliation: Ivo C Ditah, Badr F Al Bawardy, Behnam Saberi, Patrick S Kamath, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Behnam
authors.initials: B
authors.lastname: Saberi
authors.affiliation: Ivo C Ditah, Badr F Al Bawardy, Behnam Saberi, Patrick S Kamath, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Chobufo
authors.initials: C
authors.lastname: Ditah
authors.affiliation: Ivo C Ditah, Badr F Al Bawardy, Behnam Saberi, Patrick S Kamath, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
keywords: Cirrhosis; Hepatic hydrothorax; Meta-analysis; Portal hypertension; Transjugular intrahepatic portosystemic stent shunt