title: Coveredversusbare stents for transjugular intrahepatic portosystemic shunt: an updated meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Transjugular intrahepatic portosystemic shunt (TIPS) is a standard treatment option for the management of portal hypertension in liver cirrhosis. Since the introduction of covered stents, shunt patency has been greatly improved. However, it remains uncertain about whether covered stents could improve survival. A meta-analysis of randomized controlled trials has been performed to compare the outcomes of coveredversusbare stents for TIPS.
  
  
  METHODS
  PubMed, EMBASE, and Cochrane Library databases were searched to identify the relevant randomized controlled trials. Overall survival, shunt patency, and hepatic encephalopathy were the major endpoints. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was calculated. Cochrane risk of bias tool was employed.
  
  
  RESULTS
  Overall, 119 papers were identified. Among them, four randomized controlled trials were eligible. Viatorr covered stents alone, Fluency covered stents alone, and Viatorr plus Fluency covered stents were employed in one, two, and one randomized controlled trials, respectively. Risk of bias was relatively low. Meta-analyses demonstrated that the covered-stents group had significantly higher probabilities of overall survival (HR = 0.67, 95% CI = 0.50-0.90,p= 0.008) and shunt patency (HR = 0.42, 95% CI = 0.29-0.62,p< 0.0001) than the bare-stents group. Additionally, the covered-stents group might have a lower risk of hepatic encephalopathy than the bare-stents group (HR = 0.70, 95% CI = 0.49-1.00,p= 0.05). The heterogeneity among studies was not statistically significant in the meta-analyses.
  
  
  CONCLUSIONS
  Compared with bare stents, covered stents for TIPS may improve the overall survival. In the era of covered stents, the indications for TIPS may be further expanded.
authors.affiliation: Department of Gastroenterology and Meta-Analysis Study Interest Group, General Hospital of Shenyang Military Area, Shenyang, China.
authors.forename: Xingshun
authors.initials: X
authors.lastname: Qi
authors.affiliation: Department of Interventional Radiology and Key Laboratory of Diagnostic Imaging and Interventional Radiology of Liaoning Province, First Affiliated Hospital of China Medical University, Shenyang, China.
authors.forename: Yulong
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Interventional Radiology and Key Laboratory of Diagnostic Imaging and Interventional Radiology of Liaoning Province, First Affiliated Hospital of China Medical University, Shenyang, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Evidence-Based Medicine Group, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology and Meta-Analysis Study Interest Group, General Hospital of Shenyang Military Area, Shenyang, China.
authors.forename: Xiaozhong
authors.initials: X
authors.lastname: Guo
keywords: liver cirrhosis; portal hypertension; transjugular intrahepatic portosystemic shunt