EVS vs TIPS shunt for gastric variceal bleeding in patients with cirrhosis: A meta-analysis

Table 1 Characteristic of studies included

Ref.	Type of stent	Type of EVS	Randomized	Prospective study	Consecutive patients	Comparable base-line data	Definition of variceal rebleeding	Definition of post-TIPS HE	Lost (TIPS/EVS)
Mahadeva et al[13]	Bare	Cyanoacrylate	No	No	No	Yes	NR	NR	0/0
Lo et al[19]	Bare	Cyanoacrylate	Yes	Yes	Yes	No	Rebleeding from GV or EV was defined as the presence of hematemesis or melena with the bleeding source being endoscopically proven to originate from GV or EV, respectively	Patients with altered consciousness levels and elevated arterial ammonia levels requiring hospitalization were recorded as having the complication of hepatic encephalopathy	1/6
Procaccini et al[7]	29 with covered stent, 15 with bare stent	Cyanoacrylate	No	No	NR	Yes	Rebleeding was defined by a significant decrease in hemoglobin or hematocrit requiring packed red cell transfusion or evidence of hematemesis or melena with hemodynamic insufficiency	NR	NR/NR

EV: Esophageal varices; GV: Gastric varices; NR: Not reported; EVS: Endoscopic variceal sclerotherapy; TIPS: Transjugular intrahepatic portosystemic shunt.

Table 2 Characteristic of patients included

Ref.	Patients screened	Patients included Total/TIPS/EVS	Age TIPS/EVS	Gender TIPS/EVS male (female)	Child-Pugh classes TIPS/EVS			Etiology			GV anatomy TIPS/EVS
					A	B	C	Viral TIPS/EVS	Alcohol TIPS/EVS	Others TIPS/EVS	GOV1	GOV2	IGV
Mahadeva et al[13]	NR	43/20/23	52/55	13 (7)/15 (8)	4/4	6/8	10/9	0/0	12/14	8/9	13/15	7/8	0/0
Lo et al[19]	460	72/35/37	55/52	25 (10)/28 (9)	9/12	20/19	6/6	30/26	4/8	1/3	19/17	14/19	2/1
Procaccini et al[7]	NR	105/44/61	52/54.5	26 (18)/43 (18)	NR	NR	NR	14/16	17/24	13/21	NR	NR	NR

NR: Not reported; EVS: Endoscopic variceal sclerotherapy; TIPS: Transjugular intrahepatic portosystemic shunt.

Table 3 Endpoints of included studies n (%)

Ref.	Successful stent placement	Shunt stenosis	Finalpatency	EVS per patient mean ± SD	Patients crossing over to TIPS	Clinical failure TIPS/EVS	Variceal rebleeding TIPS/EVS	HE TIPS/EVS	Refractory HE TIPS/EVS	Death TIPS (%)/EVS (%)
Mahadeva et al[13]	18/20 (90)	2/20 (10)	16/20 (80)	3 ± 1.5	2 (9)	2 (10)/4 (17)	4 (20)/8 (35)	21 (10)/0 (0)	NR	1 (5)/2 (9)
Lo et al[19]	35/35 (100)	8/35 (23)	27/35 (77)	3.3 ± 1.4	1 (3)	1 (3)/3 (8)	7 (20)/19 (51)	9 (26)/1 (3)	NR	16 (46)/12 (32)
Procaccini et al[7]	NR	6/42 (14)	36/42 (86)	2 ± median	7 (11)	NR	UA	11 (25)/1 (2)	NR	14 (32)/17 (28)

¹Patients with severe HE. NR: Not reported; UA: The accurate data is unavailable; EVS: Endoscopic variceal sclerotherapy; TIPS: Transjugular intrahepatic portosystemic shunt; HE: Hepatic encephalopathy.