Efficacy and safety of transjugular intrahepatic portosystemic shunt versus endoscopic therapy for prevention of variceal rebleeding in patients with cirrhosis: a meta-analysis

Objective To compare the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic therapy (ET) in reducing recurrent variceal hemorrhage in patients with cirrhosis. Methods Data from randomized controlled trials (RCTs) ranging from January 1st, 1970 to January 1st, 2014 that compared the use of TIPS with ET for the prophylaxis of recurrent variceal bleeding in cirrhosis patients were retrieved from databases including Pub Med, Ovid, Science Direct, Embase, Wanfang Data, and CNKI. The quality of eligible RCTs was assessed, and a meta-analysis was performed on the incidence of variceal rebleeding (VRB) and post-treatment encephalopathy, deaths due to rebleeding and other causes, and hospitalization days using the Cochrane Collaboration's Rev Man 5. 2 software. Heterogeneity test and sensitivity analysis were performed, and publication biases were evaluated. Results Thirteen RCTs involving 475 cases of TIPS and480 cases of ET were recruited in our study following the inclusion criteria. The meta-analysis showed that compared with the ET group, the TIPS group had a lower incidence of VRB [relative risk (RR) = 0. 48, 95% confidence interval (CI) : 0. 39-0. 58, P < 0. 001 ], reduced deaths due to rebleeding (RR = 0. 37, 95% CI: 0. 20-0. 69, P = 0. 001) , but a higher incidence of post-treatment encephalopathy (RR = 1. 84, 95% CI: 1. 47-2. 30, P < 0. 001) . No significant differences were found in overall mortality and hospitalization days between the two groups (RR = 1. 09, 95% CI: 0. 88-1. 35, P = 0. 44; weighted mean difference =-0. 44, 95% CI:-3. 25-2. 38, P= 0. 76) . Conclusions Compared with ET, TIPS increases the risk of hepatic encephalopathy. However, in some special cases, it remains the first choice of treatment to prevent variceal rebleeding.