Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding: a systematic review and meta-analysis of controlled trials

Eur J Gastroenterol Hepatol. 2015 Sep;27(9):e1-9. doi: 10.1097/MEG.0000000000000403.


Introduction: There is conflicting evidence on the benefit of early transjugular intrahepatic portosystemic shunt (TIPSS) on the survival of patients with acute variceal bleeding (AVB).

Aim: To assess the effect of early TIPSS on patient prognosis.

Materials and methods: We carried out a meta-analysis of trials evaluating early TIPSS in cirrhotic patients with AVB.

Results: Four studies were included. Early TIPSS was associated with fewer deaths [odds ratio (OR)=0.38, 95% confidence interval (CI)=0.17-0.83, P=0.02], with moderate heterogeneity between studies (P=0.15, I=44%). Early TIPSS was not significantly associated with fewer deaths among Child-Pugh B patients (OR=0.35, 95% CI=0.10-1.17, P=0.087) nor among Child-Pugh C patients (OR=0.34, 95% CI=0.10-1.11, P=0.074). There was no heterogeneity between studies in the Child-Pugh B analysis (P=0.6, I=0%), but there was a high heterogeneity in the Child-Pugh C analysis (P=0.06, I=60%). Early TIPSS was associated with lower rates of bleeding within 1 year (OR=0.08, 95% CI=0.04-0.17, P<0.001) both among Child-Pugh B patients, (OR=0.15, 95% CI=0.05-0.47, P=0.001) and among Child-Pugh C patients (OR=0.05, 95% CI=0.02-0.15, P<0.001), with no heterogeneity between studies. Early TIPSS was not associated with higher rates of encephalopathy (OR=0.84, 95% CI=0.50-1.42, P=0.5).

Conclusion: Cirrhotic patients with AVB treated with early TIPSS had lower death rates and lower rates of clinically significant bleeding within 1 year compared with patients treated without early TIPSS. Additional studies are required to identify the potential risk factors leading to a poor prognosis after early TIPSS in patients with AVB and to determine the impact of the degree of liver failure on the patient's prognosis.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Controlled Clinical Trials as Topic
  • Esophageal and Gastric Varices / diagnosis
  • Esophageal and Gastric Varices / etiology
  • Esophageal and Gastric Varices / mortality
  • Esophageal and Gastric Varices / surgery*
  • Gastrointestinal Hemorrhage / diagnosis
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / mortality
  • Gastrointestinal Hemorrhage / surgery*
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / mortality
  • Odds Ratio
  • Portasystemic Shunt, Transjugular Intrahepatic* / adverse effects
  • Portasystemic Shunt, Transjugular Intrahepatic* / mortality
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome