Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

Figure 1 Study selection flow chart. Of a total of 301 studies that included at least 10 patients in the series, only 6 studies met selection criteria. TIPSS indicates transjugular intrahepatic portosystemic stent shunt. TIPSS: Transjugular intrahepatic portosystemic stent shunt.

Figure 2 Response to transjugular intrahepatic portosystemic stent shunt. A: Forest plot shows that most [55.8% (95%CI: 44.7%-66.9%)] of the 198 patients in the 6 studies had a complete response (resolution of refractory hepatic hydrothorax without further need for thoracentesis) after TIPSS. There was no evidence of heterogeneity among studies (P = 0.99); B: About one-fifth [17.6% (10.9%-24.2%)] of the patients had only a partial response (defined as improvement in refractory hepatic hydrothorax symptoms and/or a decrease for the need for thoracentesis). There was no evidence of heterogeneity among studies (P = 0.65); C: Just over one-fifth (21.2%) of the patients had no improvement in refractory hepatic hydrothorax after TIPSS. There was no evidence of heterogeneity among studies (P = 0.76). TIPSS indicates transjugular intrahepatic portosystemic stent shunt.

Figure 3 Mortality after transjugular intrahepatic portosystemic stent shunt. A: Forest plot shows that about one-fifth [17.74% (95%CI: 11.34%-24.13%)] of the 198 patients in the 6 studies died within 45 d of undergoing TIPSS. There was no evidence of heterogeneity among studies (P = 0.86); B: Overall mortality after TIPSS was 50.17% (95%CI: 39.63%-60.71%) at a maximum follow-up of 5 years. There was no evidence of heterogeneity among studies (P = 0.81). TIPSS indicates transjugular intrahepatic portosystemic stent shunt.

Figure 4 Encephalopathy after transjugular intrahepatic portosystemic stent. TIPSS-related hepatic encephalopathy (new onset or worsening from baseline) was noted in 11.7% (95%CI: 6.3%-17.2%) of the 198 patients in the 6 studies. There was, however, evidence of heterogeneity among the studies (P = 0.04). TIPSS indicates transjugular intrahepatic portosystemic stent shunt.