Efficacy of transjugular intrahepatic portosystemic shunt versus endoscopic cyanoacrylate injection in treatment of gastric variceal bleeding: A meta-analysis

Objective To evaluate the clinical efficacy and safety of transjugular intrahepatic portosystemic shunt ( TIPS) versus endoscopic cyanoacrylate injection in the treatment of gastric variceal bleeding through a meta-analysis. Methods Pub Med, Embase, the Cochrane Library, ScienceDirect, CNKI, and Wanfang Data were searched for the randomized controlled trials ( RCTs) of the efficacy of TIPS versus endoscopic cyanoacrylate injection in the treatment of gastric variceal bleeding published up to June 30, 2018. We assessed study quality and extracted data from the included studies. RevMan 5. 3 software was used to statistically analyze the data. Results Six RCTs were included, involving366 cases in the TIPS group and 255 cases in the cyanoacrylate group. The meta-analysis showed no significant difference in the early rebleeding rate between the TIPS group and the cyanoacrylate group ( odds ratio [OR]= 1. 05, 95% confidence interval [CI]: 0. 53-2. 06, P = 0. 89) , but the postoperative late rebleeding rate of the TIPS group was significantly lower than that of the cyanoacrylate group ( OR =0. 33, 95% CI: 0. 19-0. 57, P < 0. 000 1) . There was no significant difference in the mortality between the TIPS group and the cyanoacrylate group ( OR = 1, 95% CI: 0. 65-1. 55, P > 0. 05) . The TIPS group had a significantly increased incidence of postoperative hepatic encephalopathy compared with the cyanoacrylate group ( OR = 4. 09, 95% CI: 1. 59-10. 58, P = 0. 004) . Conclusions In the long term, the rebleeding rate of gastric variceal bleeding is significantly lower in patients treated with TIPS than in those treated with endoscopic cyanoacrylate injection, so TIPS is an effective method to treat gastric variceal bleeding.