Affiliation:
1. Hubei Clinical Center and Key Laboratory for Intestinal and Colorectal Diseases, Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
Abstract
Purpose
This meta-analysis was designed to evaluate the clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) conducted utilizing stents of different diameters, thus providing recommendations for more logical selections of covered stents for patients with portal hypertension, in particular for the Asian population.
Materials and methods
Web of Science, PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure and Wan Fang were searched for randomized controlled trials and cohort studies from inception until February 2023. The meta-analysis was carried out using Revman 5.4 Software. Heterogeneity between researches was assessed by the χ
2 test and I
2 index. The outcomes evaluated were the incidence of post-TIPS hepatic encephalopathy (HE), variceal rebleeding, shunt dysfunction, 1-year overall survival and decrease in portal pressure gradient (PPG).
Results
Eight appropriate clinical trials with 1246 patients were selected (638 and 608 patients in the experimental and control groups, respectively). In regards to preoperative PPG reduction, there was no discernible difference between the two groups [mean difference = 1.15, 95% confidence interval (CI) = −0.29–2.58, P = 0.12]. The rate of post-TIPS HE was significantly higher in patients in the 8 mm stent group than in the 6–7 mm stent group [odds ratio (OR) = 0.54, 95% CI = 0.42–0.70, P < 0.00001, I
2 = 46%]. There were no significant differences in the rates of variceal rebleeding (OR = 1.05, 95% CI = 0.67–1.65, P = 0.84, I
2 = 0%), shunt dysfunction (OR = 0.88, 95% CI = 0.53–1.47, P = 0.64, I
2 = 0%) and 1-year overall survival (OR = 0.86, 95% CI = 0.50–1.50, P = 0.61, I
2 = 0%).
Conclusion
Asian populations with portal hypertension may benefit more from TIPS with 6–7 mm covered stents because they can reduce the risk of postoperative HE while offering similar efficacy when compared to 8 mm covered stents.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Gastroenterology,Hepatology