Xu XT, Jiang MJ, Fu YL, Xie F, Li JJ, Meng QH. Incidence and efficacy of strategies for preventing hepatic encephalopathy following transjugular intrahepatic portosystemic shunt: A meta-analysis. World J Hepatol 2025; 17(4): 104890 [DOI: 10.4254/wjh.v17.i4.104890]
Corresponding Author of This Article
Qing-Hua Meng, Hepatic Disease and Oncology Minimally Invasive Interventional Center, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmen Wai, Fengtai District, Beijing 100069, China. meng_qh0805@ccmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Tong Xu, Jian-Jun Li, Qing-Hua Meng, Hepatic Disease and Oncology Minimally Invasive Interventional Center, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Xiao-Tong Xu, Yun-Lai Fu, Fang Xie, Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Min-Jie Jiang, Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Co-corresponding authors: Jian-Jun Li and Qing-Hua Meng.
Author contributions: Li JJ and Meng QH contribute equally to this study as co-corresponding authors; Xu XT, Jiang MJ, and Fu YL contributed to the literature database retrieval, data collection, and data extraction; Xu XT, Xie F, Li JJ, and Meng QH conceptualized the topic; Li JJ, Xie F, and Meng QH reviewed the article; Li JJ and Meng QH participated and provided valuable feedback, ensuring the quality of the article and contributing as co-corresponding authors; all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All authors disclosed no relevant relationships.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qing-Hua Meng, Hepatic Disease and Oncology Minimally Invasive Interventional Center, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmen Wai, Fengtai District, Beijing 100069, China. meng_qh0805@ccmu.edu.cn
Received: January 5, 2025 Revised: February 27, 2025 Accepted: April 7, 2025 Published online: April 27, 2025 Processing time: 109 Days and 21.6 Hours
Abstract
BACKGROUND
Hepatic encephalopathy (HE) is a primary complication following transjugular intrahepatic portosystemic shunt (TIPS), but the utility of pharmacological prophylaxis for HE is unclear.
AIM
To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.
METHODS
A thorough literature search was performed in PubMed, Web of Science, EMBASE, and the Cochrane Library databases from their inception to November 24, 2024, to collect data regarding HE incidence. The main outcome was HE incidence post-TIPS. A meta-analysis using a random effects model was performed to obtain odds ratios (ORs) and 95% confidence intervals. Statistical analyses were conducted using Stata and RevMan software.
RESULTS
This meta-analysis included nine studies with 1140 patients; 647 received pharmacological agents including lactulose, rifaximin, albumin, and l-ornithin-l-aspartate, and 493 did not (controls). (1) In the single-group meta-analysis, the control group had higher short- and long-term HE rates than the drug intervention group. Among patients with and without prior HE, the non-intervention group's HE rates were also higher; (2) Pharmacological prevention post-TIPS significantly reduced HE incidence [OR = 0.59 (0.45, 0.77), P = 0.0001]. Compared with the no prophylaxis, rifaximin reduced the risk of HE after TIPS [OR = 0.52 (0.29, 0.95), P = 0.03], but lactulose did not; (3) In patients without prior HE, pharmacological prevention significantly reduced post-TIPS HE incidence [OR = 0.62 (0.41,0.95), P = 0.03]; and (4) Network meta-analysis showed no significant differences among five prevention strategies.
CONCLUSION
The HE incidence after TIPS was relatively high, and the use of drugs after TIPS may reduce the HE incidence. However, research, especially large-scale randomized controlled trials, is still lacking.
Core Tip: Hepatic encephalopathy (HE) is a common complication after transjugular intrahepatic portosystemic shunt (TIPS) that affects the quality of life of patients and their families. However, controversy exists regarding about whether TIPS patients need medication to prevent and reduce HE occurrence after surgery. We found through a meta-analysis that the HE incidence after TIPS surgery is relatively high and that drug prevention can significantly reduce HE occurrence. Moreover, current prevention strategies are summarized to provide guidance for future clinical research.
