title: Covered TIPS for secondary prophylaxis of variceal bleeding in liver cirrhosis: A systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  In the era of bare stents, transjugular intrahepatic portosystemic shunt (TIPS) is the second-line choice of therapy for the prevention of variceal rebleeding in liver cirrhosis. In the era of covered stents, the role of TIPS should be re-evaluated.
  
  
  OBJECTIVE
  The aim of the study was to compare the outcomes of covered TIPS versus the traditional first-line therapy (i.e, drug plus endoscopic therapy) for the prevention of variceal rebleeding in liver cirrhosis.
  
  
  METHODS
  All relevant randomized controlled trials were searched via the PubMed, EMBASE, and Cochrane Library databases. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) and P values were calculated for the cumulative risk and overall risk, respectively. Heterogeneity among studies was also calculated.
  
  
  RESULTS
  Three of 111 retrieved papers were eligible. Among them, the proportion of patients who were switched from drug plus endoscopic therapy to TIPS was 16% to 25%. The risk of bias was relatively low in all included randomized controlled trials. Meta-analyses demonstrated that the covered TIPS group had a similar overall survival (HR = 0.84, 95% CI = 0.55-1.28, P = 0.41; OR = 1.00, 95% CI = 0.59-1.69, P = 0.99), a significantly lower risk of variceal rebleeding (HR = 0.30, 95% CI = 0.18-0.48, P < 0.00001; OR = 0.24, 95% CI = 0.12-0.46, P < 0.0001), and a similar risk of hepatic encephalopathy (HR = 1.35, 95% CI = 0.72-2.53, P = 0.36; OR = 1.28, 95% CI = 0.54-3.04, P = 0.57). In most of meta-analyses, the heterogeneity among studies was not statistically significant.
  
  
  CONCLUSIONS
  Compared with drug plus endoscopic therapy, covered TIPS had a significant benefit of preventing from variceal rebleeding, but did not increase the overall survival or risk of hepatic encephalopathy.
authors.affiliation: Liver Cirrhosis Study Group & Meta-analysis Study Interest Group, Department of Gastroenterology, General Hospital of Shenyang Military Area Department of Interventional Radiology & Key Laboratory of Diagnostic Imaging and Interventional Radiology of Liaoning Province, First Affiliated Hospital of China Medical University Medical Ethical Committee, General Hospital of Shenyang Military Area, Shenyang Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Xingshun
authors.initials: X
authors.lastname: Qi
authors.forename: Yulong
authors.initials: Y
authors.lastname: Tian
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Haitao
authors.initials: H
authors.lastname: Zhao
authors.forename: Guohong
authors.initials: G
authors.lastname: Han
authors.forename: Xiaozhong
authors.initials: X
authors.lastname: Guo
mesh_terms: D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention / Q000379:methods; D016896:Treatment Outcome