Transjugular intrahepatic portosystemic shunt with or without variceal embolization to prevent variceal rebleeding: an updated meta-analysis

ABSTRACT

Background

Transjugular 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 methods

We 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.

Results

We 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).

Conclusions

TIPS 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.

KEYWORDS:

• TIPS
• portal hypertension
• variceal bleeding
• variceal embolization
• meta-analysis

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

MT Abuelazm: methodology, formal analysis, resources, writing – review & editing, supervision. HA Cheema: conceptualization, methodology, formal analysis, resources, writing – review & editing, supervision. U Jafar: formal analysis, data curation, writing- original draft preparation. AK Awad: conceptualization, formal analysis, investigation, writing- original draft preparation. M Atef: formal analysis, investigation, writing- original draft preparation. H Abdalshafy: validation, writing- original draft preparation. M Alashwah: software, validation, formal analysis, writing- original draft preparation. A Shahid: conceptualization, investigation, writing – review & editing. RU Awan: conceptualization, data curation, writing- original draft preparation. AM Afifi: methodology, writing- reviewing and editing, visualization, supervision. PK Jalal: resources, writing – review & editing, project administration. H Aziz: writing – review & editing, supervision, project administration. Final approval of the version to be published: all authors. All authors agree to be accountable for all aspects of the work.

Availability of data

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474124.2023.2223974.

Additional information

Funding

This paper was not funded.