Comparison of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Alone Versus TIPS Combined With Embolotherapy in Advanced Cirrhosis

Abstract

The results suggest that TIPS with embolotherapy cannot reduce the risk of rebleeding if PPG is less than 12 mm Hg after TIPS. PPG after TIPS is an independent predictor of rebleeding.

Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: A meta‐analysis

“…The group of TIPS with surgical portal azygous disconnection was further excluded from our meta‐analysis . Thus, a total of six articles were included in our meta‐analysis …”

“…The type of stents was covered stent alone in two studies, bare stent alone in two studies, both bare and covered stent in one study, and unknown in one study . Varices were angiographically embolized by coils with or without liquids agents in all studies . Liquids agents were employed in three studies, including α‐cyanoacrylate ( n = 1), ethanol ( n = 1), and sclerosing agents ( n = 1).…”

“…Six studies reported the data regarding the incidence of variceal rebleeding . The heterogeneity among studies was considered to be not significant ( I 2 = 10%, P = 0.35).…”

“…21,22 However, other researchers found a similar incidence of variceal rebleeding between the two groups. 23,24 Given inconsistent conclusions achieved by these literatures, we conducted a meta-analysis to systematically compare the incidence of shunt dysfunction, variceal rebleeding, encephalopathy, and death between patients treated with TIPS alone and those treated with TIPS combined with variceal embolization.…”

Persistence of gastric or esophageal varices on final angiography increases transjugular intrahepatic portosystemic shunt revision rate after polytetrafluoroethylene-covered stent shunt creation

“…A meta-analysis reported that patients with TIPS + variceal embolization had significantly lower rebleeding (OR=2.02, P=0.002) but similar incidences of shunt dysfunction, HE, and death than patients with TIPS alone (40). Furthermore, Xiao et al (41) found no difference in incidence of rebleeding, shunt revision, encephalopathy, and overall survival in patients with portosystemic gradient ≤12 mmHg after stent implantation and angioplasty. However, portosystemic gradient after TIPS placement was an independent predictor of rebleeding (P=0.036).…”