Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding: a systematic review and meta-analysis of controlled trials. Issue 9 (September 2015) - Deltenre, Pierre
Abstract : Introduction: There is conflicting evidence on the benefit of early transjugular intrahepatic portosystemic shunt (TIPSS) on the survival of patients with acute variceal bleeding (AVB). Aim: To assess the effect of early TIPSS on patient prognosis. Materials and methods: We carried out a meta-analysis of trials evaluating early TIPSS in cirrhotic patients with AVB. Results: Four studies were included. Early TIPSS was associated with fewer deaths [odds ratio (OR)=0.38, 95% confidence interval (CI)=0.17–0.83, P =0.02], with moderate heterogeneity between studies ( P =0.15, I 2 =44%). Early TIPSS was not significantly associated with fewer deaths among Child–Pugh B patients (OR=0.35, 95% CI=0.10–1.17, P =0.087) nor among Child–Pugh C patients (OR=0.34, 95% CI=0.10–1.11, P =0.074). There was no heterogeneity between studies in the Child–Pugh B analysis ( P =0.6, I 2 =0%), but there was a high heterogeneity in the Child–Pugh C analysis ( P =0.06, I 2 =60%). Early TIPSS was associated with lower rates of bleeding within 1 year (OR=0.08, 95% CI=0.04–0.17, P <0.001) both among Child–Pugh B patients, (OR=0.15, 95% CI=0.05–0.47, P =0.001) and among Child–Pugh C patients (OR=0.05, 95% CI=0.02–0.15, P <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, P =0.5). Conclusion: 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.