Transjugular intrahepatic portosystemic shunt versus endoscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients: meta-analysis update

J Clin Gastroenterol. May-Jun 2008;42(5):507-16. doi: 10.1097/MCG.0b013e31815576e6.

Abstract

Goals: The aim of this study was to determine through meta-analysis the effects of transjugular intrahepatic portosystemic shunt (TIPS) for the reduction of variceal rebleeding (VRB).

Background: Variceal bleeding is one of the most frequent and severe complications of chronic liver disease. Although prophylactic use of TIPS for the reduction of VRB has been evaluated, the discrepancy about TIPS's beneficial effect on cirrhotic patients still exists.

Study: We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trials (RCTs) of TIPS versus endoscopic therapy in the prevention of VRB including 12 RCTs conducted in 7 different countries.

Results: Most RCTs reviewed were of high quality. The updated meta-analysis showed that the decreased incidence of VRB [odds ratio (OR)=0.32, 95% confidence interval (CI) (0.24-0.43), P<0.00001], deaths due to rebleeding [OR=0.35, 95% CI (0.18-0.67), P=0.002], the increased rate of posttreatment encephalopathy [OR=2.21, 95% CI (1.61-3.03), P<0.00001] were correlated with TIPS, whereas the hospitalization days [weighted mean difference=-0.21, 95% CI (-3.50 to 3.08), P=0.90] and deaths due to all causes [OR=1.17, 95% CI (0.85-1.61), P=0.33] returned negative results in 2 groups.

Conclusions: TIPS is currently the first choice to prevent rebleeding except that TIPS is worse than endoscopic therapy for encephalopathy. An exploration of new approaches out of above complications will be of considerable clinical significance and be a challenge to clinicians.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Endoscopy, Digestive System / methods*
  • Esophageal and Gastric Varices / complications*
  • Esophageal and Gastric Varices / surgery
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / prevention & control*
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / surgery
  • Portasystemic Shunt, Transjugular Intrahepatic / methods*
  • Secondary Prevention
  • Treatment Outcome