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Early transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a systematic review and meta-analysis.
- Source :
-
European Radiology . Jul2021, Vol. 31 Issue 7, p5390-5399. 10p. 1 Diagram, 1 Chart, 3 Graphs. - Publication Year :
- 2021
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Abstract
- Objectives: The alleged benefit of early placement of transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis and acute variceal bleeding (AVB) remains controversial. This meta-analysis was conducted to evaluate the therapeutic effect of early TIPS on cirrhotic patients with AVB. Methods: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant literatures. Data from included studies were extracted, and random-effects meta-analyses were performed. Results: Three randomized control trials and six observational studies involving 2878 participants were included. Compared with those undergoing standard treatment, patients undergoing early TIPS had a significantly lower all-cause mortality (RR, 0.64; 95% CI, 0.52–0.79). Furthermore, early TIPS was associated with a significantly reduced incidence of failure to control bleeding (RR, 0.15; 95% CI, 0.07–0.29) and rebleeding (RR, 0.40; 95% CI, 0.23–0.71), without increasing the risk of hepatic encephalopathy (RR, 1.13; 95% CI, 0.92–1.38). In a stratification analysis based on Child-Pugh classification, the survival benefit was observed in Child-Pugh B patients with active bleeding (RR, 0.53; 95% CI, 0.31–0.93) and Child-Pugh C patients (RR 0.55, 95% CI, 0.37–0.82), but not in low-risk patients (Child-Pugh A and Child-Pugh B without active bleeding) (RR, 0.93; 95% CI, 0.55–1.57). Conclusion: Early TIPS is a feasible therapeutic option for cirrhotic patients with AVB, especially benefiting high-risk patients in terms of improved survival. Given the current low utilization rate in clinical practice, this study favors the placement of early TIPS in a wider range of patients with cirrhosis and AVB, especially high-risk patients. Key Points: • Early TIPS is associated with improved survival in high-risk patients (Child-Pugh B plus active bleeding at endoscopy or Child-Pugh C 10–13) with cirrhosis and acute variceal bleeding. • Current utilization rate of early TIPS is low in clinical practice. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 09387994
- Volume :
- 31
- Issue :
- 7
- Database :
- Academic Search Index
- Journal :
- European Radiology
- Publication Type :
- Academic Journal
- Accession number :
- 150974470
- Full Text :
- https://doi.org/10.1007/s00330-020-07525-x