Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Deltenre, Pierre; Trépo, Eric; Rudler, Marika; Monescillo, Alberto; Fraga, Montserrat; Denys, Alban; Doerig, Christopher; Fournier, Nicolas; Moreno, Christophe; Moradpour, Darius; Bureau, Christophe; Thabut, Dominique
• Is Part Of: European journal of gastroenterology & hepatology. Volume 27:Issue 9(2015:Sep.)
• Publication Date: 2015-09
• Subjects: Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000000403
• Languages: English
• ISSNs: 0954-691X

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Introduction</title> <p>There is conflicting evidence on the benefit of early transjugular intrahepatic portosystemic shunt (TIPSS) on the survival of patients with acute variceal bleeding (AVB).</p> </sec> <sec> <title>Aim</title> <p>To assess the effect of early TIPSS on patient prognosis.</p> </sec> <sec> <title>Materials and methods</title> <p>We carried out a meta-analysis of trials evaluating early TIPSS in cirrhotic patients with AVB.</p> </sec> <sec> <title>Results</title> <p>Four studies were included. Early TIPSS was associated with fewer deaths [odds ratio (OR)=0.38, 95% confidence interval (CI)=0.17–0.83, <italic>P</italic>=0.02], with moderate heterogeneity between studies (<italic>P</italic>=0.15, <italic>I</italic><sup><italic>2</italic></sup>=44%). Early TIPSS was not significantly associated with fewer deaths among Child–Pugh B patients (OR=0.35, 95% CI=0.10–1.17, <italic>P</italic>=0.087) nor among Child–Pugh C patients (OR=0.34, 95% CI=0.10–1.11, <italic>P</italic>=0.074). There was no heterogeneity between studies in the Child–Pugh B analysis (<italic>P</italic>=0.6, <italic>I</italic><sup>2</sup>=0%), but there was a high heterogeneity in the Child–Pugh C analysis (<italic>P</italic>=0.06, <italic>I</italic><sup><italic>2</italic></sup>=60%). Early TIPSS was associated with lower rates of bleeding within 1 year (OR=0.08, 95% CI=0.04–0.17, <italic>P</italic><0.001) both among Child–Pugh B patients, (OR=0.15, 95% CI=0.05–0.47, <italic>P</italic>=0.001) and among Child–Pugh C patients (OR=0.05, 95% CI=0.02–0.15, <italic>P</italic><0.001), with no heterogeneity between studies. Early TIPSS was not associated with higher rates of encephalopathy (OR=0.84, 95% CI=0.50–1.42, <italic>P</italic>=0.5).</p> </sec> <sec> <title>Conclusion</title> <p>Cirrhotic patients with AVB treated with early TIPSS had lower death rates and lower rates of clinically significant bleeding within 1 year compared with patients treated without early TIPSS. Additional studies are required to identify the potential risk factors leading to a poor prognosis after early TIPSS in patients with AVB and to determine the impact of the degree of liver failure on the patient's prognosis.</p> </sec> </abstract>