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European Radiology

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01-07-2021 | Hepatic Encephalopathy | Interventional

Early transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a systematic review and meta-analysis

Authors: Guang-Peng Zhou, Yi-Zhou Jiang, Li-Ying Sun, Zhi-Jun Zhu

Published in: European Radiology | Issue 7/2021

Abstract

Objectives

The alleged benefit of early placement of transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis and acute variceal bleeding (AVB) remains controversial. This meta-analysis was conducted to evaluate the therapeutic effect of early TIPS on cirrhotic patients with AVB.

Methods

MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant literatures. Data from included studies were extracted, and random-effects meta-analyses were performed.

Results

Three randomized control trials and six observational studies involving 2878 participants were included. Compared with those undergoing standard treatment, patients undergoing early TIPS had a significantly lower all-cause mortality (RR, 0.64; 95% CI, 0.52–0.79). Furthermore, early TIPS was associated with a significantly reduced incidence of failure to control bleeding (RR, 0.15; 95% CI, 0.07–0.29) and rebleeding (RR, 0.40; 95% CI, 0.23–0.71), without increasing the risk of hepatic encephalopathy (RR, 1.13; 95% CI, 0.92–1.38). In a stratification analysis based on Child-Pugh classification, the survival benefit was observed in Child-Pugh B patients with active bleeding (RR, 0.53; 95% CI, 0.31–0.93) and Child-Pugh C patients (RR 0.55, 95% CI, 0.37–0.82), but not in low-risk patients (Child-Pugh A and Child-Pugh B without active bleeding) (RR, 0.93; 95% CI, 0.55–1.57).

Conclusion

Early TIPS is a feasible therapeutic option for cirrhotic patients with AVB, especially benefiting high-risk patients in terms of improved survival. Given the current low utilization rate in clinical practice, this study favors the placement of early TIPS in a wider range of patients with cirrhosis and AVB, especially high-risk patients.

Key Points

• Early TIPS is associated with improved survival in high-risk patients (Child-Pugh B plus active bleeding at endoscopy or Child-Pugh C 10–13) with cirrhosis and acute variceal bleeding.

• Current utilization rate of early TIPS is low in clinical practice.

Available only for authorised users

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Title: Early transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a systematic review and meta-analysis
Authors: Guang-Peng Zhou
Yi-Zhou Jiang
Li-Ying Sun
Zhi-Jun Zhu
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Keywords: Hepatic Encephalopathy
Liver Cirrhosis
Hepatic Encephalopathy
Published in: European Radiology / Issue 7/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07525-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a systematic review and meta-analysis

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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