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Meta-Analysis
. 2022 Oct;10(8):874-887.
doi: 10.1002/ueg2.12300. Epub 2022 Oct 10.

Salvage transjugular intrahepatic portosystemic shunt in patients with cirrhosis and refractory variceal bleeding: A systematic review with meta-analysis

Laura Weichselbaum  1   2 , Antonia Lepida  2 , Astrid Marot  3 , Eric Trépo  2   4 , Christophe Moreno  2   4 , Pierre Deltenre  1   2   3
Affiliations
Meta-Analysis

Salvage transjugular intrahepatic portosystemic shunt in patients with cirrhosis and refractory variceal bleeding: A systematic review with meta-analysis

Laura Weichselbaum et al. United European Gastroenterol J. 2022 Oct.

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) may be used as a salvage treatment in patients with cirrhosis and refractory variceal bleeding.

Aim: To synthesize the available evidence on the efficacy of TIPS in patients with cirrhosis and refractory variceal bleeding.

Methods: Meta-analysis of trials evaluating TIPS in patients with cirrhosis and refractory variceal bleeding, including subgroup analysis to assess the impact of recent changes in the management of variceal bleeding (i.e., the use of Polytetrafluoroethylene-covered TIPS and the availability of pre-emptive TIPS as a first-line treatment for acute variceal bleeding).

Results: Twenty-three studies with 1430 patients were included. The pooled estimate rates were 0.33 (95% CI = 0.29-0.37) for death at 1 month-6 weeks, 0.46 (95% CI = 0.40-0.52) for death at 1 year, and 0.09 (95% CI = 0.06-0.11) for death due to rebleeding in the follow-up. The pooled estimate rates for death at 1 month or 6 weeks were similar in subgroup analyses including studies that did not use covered TIPS or that did not include patients after the pre-emptive TIPS area compared to the ones that did (pooled estimate rate 0.33 [95% CI = 0.28-0.38] and 0.32 [95% CI = 0.25-0.39], respectively). The pooled estimate rates were 0.16 (95% CI = 0.13-0.18) for rebleeding, 0.25 (95% CI = 0.17-0.36) for occurrence of hepatic encephalopathy, and 0.08 (95% CI = 0.05-0.13) for access to liver transplantation after TIPS insertion.

Conclusions: One third of patients with cirrhosis and refractory variceal bleeding treated with salvage TIPS died within the first 6 weeks. Recent improvements in the management of variceal bleeding did not improve the survival of patients presenting with refractory variceal bleeding.

Keywords: cirrhosis; portal hypertension; refractory variceal bleeding; transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

No conflicts of interest exist for any of the authors in relation to this study.

Figures

FIGURE 1
FIGURE 1
Flow chart of the selection of studies for inclusion in the meta‐analysis
FIGURE 2
FIGURE 2
Death after transjugular intrahepatic portosystemic shunt (TIPS) insertion: Pooled estimate rate for death 1 month–6 weeks (a) or 1 year (b) after TIPS insertion in patients with cirrhosis and refractory variceal bleeding. Studies before (group A) or after (group B) the use of PTFE‐covered TIPS and the pre‐emptive TIPS recommendation. TIPS, transjugular intrahepatic portosystemic shunt
FIGURE 3
FIGURE 3
Rebleeding after transjugular intrahepatic portosystemic shunt (TIPS) insertion: Pooled estimate rate for death from rebleeding (a) or occurrence of rebleeding at 6 weeks (b) in patients with cirrhosis and refractory variceal bleeding. Studies before (group A) or after (group B) the use of PTFE‐covered TIPS and the pre‐emptive TIPS recommendation. TIPS, transjugular intrahepatic portosystemic shunt
FIGURE 4
FIGURE 4
Occurrence of hepatic encephalopathy: Pooled estimate rate for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) insertion in patients with cirrhosis and refractory variceal bleeding. Studies before (group A) or after (group B) the use of PTFE‐covered TIPS and the pre‐emptive TIPS recommendation. TIPS, transjugular intrahepatic portosystemic shunt
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