Meta-Analysis
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World J Gastrointest Pharmacol Ther. May 6, 2014; 5(2): 97-104
Published online May 6, 2014. doi: 10.4292/wjgpt.v5.i2.97
EVS vs TIPS shunt for gastric variceal bleeding in patients with cirrhosis: A meta-analysis
Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Kai-Chun Wu, Dai-Ming Fan, Guo-Hong Han
Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Dai-Ming Fan, Guo-Hong Han, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
Ming Bai, Xing-Shun Qi, Zhi-Ping Yang, Kai-Chun Wu, Dai-Ming Fan, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
Author contributions: Bai M and Qi XS contributed equally to this work; Bai M, Qi XS, Wu KC, Fan DM and Han GH designed the research; Bai M, Qi XS and Yang ZP performed the research and analyzed the data; Bai M, Qi XS and Han GH wrote the paper.
Correspondence to: Guo-Hong Han, MD, Professor, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.127 Changlexi Road, Xi’an 710032, Shaanxi Province, China. hangh2009@gmail.com
Telephone: +86-29-84771528   Fax: +86-29-82539041
Received: November 11, 2013
Revised: January 22, 2014
Accepted: March 13, 2014
Published online: May 6, 2014
Processing time: 189 Days and 16.2 Hours
Abstract

AIM: To evaluate the clinical effects of transjugular intrahepatic portosystemic shunt (TIPS) vs endoscopic variceal sclerotherapy (EVS) in the management of gastric variceal (GV) bleeding in terms of variceal rebleeding, hepatic encephalopathy (HE), and survival by meta-analysis.

METHODS: Medline, Embase, and CNKI were searched. Studies compared TIPS with EVS in treating GV bleeding were identified and included according to our predefined inclusion criteria. Data were extracted independently by two of our authors. Studies with prospective randomized design were considered to be of high quality. Hazard ratios (HRs) or odd ratios (ORs) were calculated using a fixed-effects model when there was no inter-trial heterogeneity. Oppositely, a random-effects model was employed.

RESULTS: Three studies with 220 patients who had at least one episode of GV bleeding were included in the present meta-analysis. The proportions of patients with viral cirrhosis and alcoholic cirrhosis were 39% (range 0%-78%) and 36% (range 12% to 41%), respectively. The pooled incidence of variceal rebleeding in the TIPS group was significantly lower than that in the EVS group (HR = 0.3, 0.35, 95%CI: 0.17-0.71, P = 0.004). However, the risk of the development of any degree of HE was significantly increased in the TIPS group (OR = 15.97, 95%CI: 3.61-70.68). The pooled HR of survival was 1.26 (95%CI: 0.76-2.09, P = 0.36). No inter-trial heterogeneity was observed among these analyses.

CONCLUSION: The improved effect of TIPS in the prevention of GV rebleeding is associated with an increased risk of HE. There is no survival difference between the TIPS and EVS groups. Further studies are needed to evaluate the survival benefit of TIPS in cirrhotic patients with GV bleeding.

Keywords: Gastric variceal bleeding; Transjugular intrahepatic portosystemic shunt; Endoscopic variceal sclerotherapy; Cirrhosis; Hepatic encephalopathy

Core tip: This meta-analysis provides evidence-based guidance regarding the effect of transjugular intrahepatic portosystemic shunt and endoscopic variceal sclerotherapy on rebleeding, hepatic encephalopathy, and survival. The results suggest that transjugular intrahepatic portosystemic shunt is more effective than endoscopic variceal sclerotherapy in the prevention of gastric variceal rebleeding, but is associated with an increased risk of hepatic encephalopathy.