Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis

Abstract

Background and Aim. Upper gastrointestinal bleeding is a threat to patients with gastric varices (GVs). Previous studies have concluded that both transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are effective treatments for patients with GV. We aimed to compare the efficiency and outcomes of these two procedures in GV patients through meta-analysis. Methods. The PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched using the keywords: GV, bleeding, TIPS, and BRTO to identify relevant randomized controlled trials and cohort studies. The overall survival (OS) rate, imminent haemostasis rate, rebleeding rate, technical success rate, procedure complication rate (hepatic encephalopathy and aggravated ascites), and Child-Pugh score were evaluated. Randomized clinical trials and cohort studies comparing TIPS and BRTO for GV due to portal hypertension were included in our meta-analysis. Two independent reviewers performed data extraction and assessed the study quality. A meta-analysis was performed to calculate risk ratios (RRs), mean differences (MDs), and 95% CIs using random effects models. Results. A total of nine studies fulfilled the inclusion criteria. There was a significant difference between TIPS and BRTO in the OS rate (RR, 0.81 (95% CI, 0.66 to 0.98); P=0.03) and rebleeding rate (RR, 2.61 (95% CI, 1.75 to 3.90); P<0.00001). TIPS had a higher incidence rate of hepatic encephalopathy (RR, 16.11 (95% CI, 7.13 to 36.37); P<0.00001). There was no significant difference between TIPS and BRTO in the immediate haemostasis rate (RR, 0.99 (95% CI, 0.89 to 1.10); P=0.84), technical success rate (RR, 1.06 (95% CI, 0.98 to 1.16); P=0.16), aggravated ascites rate (RR, 0.60 (95% CI, 0.33 to 1.09); P=0.10), or Child-Pugh change (MD, 0.22 (95% CI, −0.21 to 0.65); P=0.31). Conclusions. In this meta-analysis, BRTO brought more benefits to patients, with a higher OS rate and lower rebleeding rate. BRTO is a feasible method for GVB.

Balloon-occluded retrograde transvenous obliteration for treatment of gastric varices

“…Table 4 shows the notable complications after each procedure. Recent meta-analyses[ 45 - 47 ] have concluded that BRTO in patients with GVs bleeding is associated with lower rates of rebleeding and postprocedural hepatic encephalopathy, as well as better survival than TIPS. Although BRTO is effective in eradicating GVs, it is associated with complications such as postprocedural EVs, ectopic varices, and intractable ascites.…”

Expanding Indications of TIPS in the Management of Portal Hypertension Complications

“…They reported a significant difference in overall survival (risk ratio [RR]: 0.81; p ¼ 0.03) and rebleeding rates (RR: 2.61; p ¼ 0.03) between TIPS and BRTO groups. 47 In conclusion, the benefits and complications of TIPS and BRTO complement each other, and recently there has been increased application of combined TIPS-BRTO in the management of GV. Implementing BRTO first provides an advantage of increasing the portal vein diameter, making access to TIPS less challenging.…”

Managing liver cirrhotic complications: Overview of esophageal and gastric varices

“…58 In a recent meta-analysis, BRTO was also found to be superior to TIPS for fundal GV in terms of higher overall survival rate and lower rebleeding rates. 59 Endoscopic hemospray is another innovation in the management of AVB. TC-325 is a hemostatic powder which adheres to bleeding site and achieves rapid hemostasis when it came into contact with blood or tissue in the gastrointestinal tract.…”