Journal article
Transjugular intrahepatic portosystemic shunt with or without variceal embolization to prevent variceal rebleeding: an updated meta-analysis
Expert review of gastroenterology & hepatology, Vol.17(7), pp.741-751
07/03/2023
DOI: 10.1080/17474124.2023.2223974
PMID: 37306478
Abstract
BackgroundTransjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension complications. Still, the role of adjuvant variceal embolization is a matter of debate. Thus, we aim to evaluate the efficacy and safety of TIPS with variceal embolization versus TIPS alone to prevent variceal rebleeding.Research design and methodsWe used PubMed, CENTRAL, and OVID to search for all randomized controlled trials (RCTs) and comparative observational studies up to 17 June 20221117 June 2022. We pooled binary outcomes using risk ratios (RRs) presented with 95% confidence intervals (CIs) using RevMan 5.4.ResultsWe included 11 studies (two RCTs and nine observational studies) with 1024 patients. Pooled RR favored TIPS with embolization in preventing variceal rebleeding (RR 0.58, 95% CI: 0.44, 0.76); however, there was no difference between the two groups regarding shunt dysfunction (RR 0.92, 95% CI: 0.68, 1.23), encephalopathy (RR 0.88, 95% CI: 0.70, 1.11), and death (RR 0.97, 95% CI: 0.77, 1.22).ConclusionsTIPS with embolization can be an effective strategy for preventing variceal rebleeding; however, our results should be interpreted cautiously as most data were observational and the technical quality of the embolization is questionable. Further RCTs are required using the proper techniques of embolization and comparing TIPS with embolization with other treatment modalities such as endoscopic ligation, and balloon-occluded retrograde transvenous obliteration.
Details
- Title: Subtitle
- Transjugular intrahepatic portosystemic shunt with or without variceal embolization to prevent variceal rebleeding: an updated meta-analysis
- Creators
- Mohamed T. Abuelazm - Tanta UniversityHuzaifa Ahmad Cheema - King Edward Medical UniversityUzair Jafar - King Edward Medical UniversityAhmed K. Awad - Ain Shams UniversityMostafa Atef - Cairo UniversityHassan Abdalshafy - Cairo UniversityMahmoud Alashwah - Cairo UniversityAbia Shahid - King Edward Medical UniversityRehmat Ullah Awan - Ochsner Rush Med Ctr, Dept Med, Meridian, MS USAAhmed M. Afifi - Univ Texas Houston, Dept Gastroenterol Hepatol & Nutr, Houston, TX USAPrasun K. Jalal - Baylor College of MedicineHassan Aziz - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Expert review of gastroenterology & hepatology, Vol.17(7), pp.741-751
- Publisher
- Taylor & Francis
- DOI
- 10.1080/17474124.2023.2223974
- PMID
- 37306478
- ISSN
- 1747-4124
- eISSN
- 1747-4132
- Number of pages
- 11
- Language
- English
- Date published
- 07/03/2023
- Academic Unit
- Surgery
- Record Identifier
- 9984701644902771
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