Article ; Online: Effectiveness and prognosis of covered stents with different diameters in transjugular intrahepatic portosystemic shunt: a meta-analysis.
European journal of gastroenterology & hepatology
2023 Volume 36, Issue 2, Page(s) 229–237
Abstract: Purpose: This meta-analysis was designed to evaluate the clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) conducted utilizing stents of different diameters, thus providing recommendations for more logical selections of covered ... ...
Abstract | Purpose: This meta-analysis was designed to evaluate the clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) conducted utilizing stents of different diameters, thus providing recommendations for more logical selections of covered stents for patients with portal hypertension, in particular for the Asian population. Materials and methods: Web of Science, PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure and Wan Fang were searched for randomized controlled trials and cohort studies from inception until February 2023. The meta-analysis was carried out using Revman 5.4 Software. Heterogeneity between researches was assessed by the χ2 test and I2 index. The outcomes evaluated were the incidence of post-TIPS hepatic encephalopathy (HE), variceal rebleeding, shunt dysfunction, 1-year overall survival and decrease in portal pressure gradient (PPG). Results: Eight appropriate clinical trials with 1246 patients were selected (638 and 608 patients in the experimental and control groups, respectively). In regards to preoperative PPG reduction, there was no discernible difference between the two groups [mean difference = 1.15, 95% confidence interval (CI) = -0.29-2.58, P = 0.12]. The rate of post-TIPS HE was significantly higher in patients in the 8 mm stent group than in the 6-7 mm stent group [odds ratio (OR) = 0.54, 95% CI = 0.42-0.70, P < 0.00001, I2 = 46%]. There were no significant differences in the rates of variceal rebleeding (OR = 1.05, 95% CI = 0.67-1.65, P = 0.84, I2 = 0%), shunt dysfunction (OR = 0.88, 95% CI = 0.53-1.47, P = 0.64, I2 = 0%) and 1-year overall survival (OR = 0.86, 95% CI = 0.50-1.50, P = 0.61, I2 = 0%). Conclusion: Asian populations with portal hypertension may benefit more from TIPS with 6-7 mm covered stents because they can reduce the risk of postoperative HE while offering similar efficacy when compared to 8 mm covered stents. |
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MeSH term(s) | Humans ; Portasystemic Shunt, Transjugular Intrahepatic/adverse effects ; Esophageal and Gastric Varices/therapy ; Esophageal and Gastric Varices/complications ; Gastrointestinal Hemorrhage ; Prognosis ; Hypertension, Portal/surgery ; Hypertension, Portal/complications ; Stents/adverse effects ; Hepatic Encephalopathy/etiology ; Hepatic Encephalopathy/epidemiology ; Treatment Outcome |
Language | English |
Publishing date | 2023-12-10 |
Publishing country | England |
Document type | Meta-Analysis ; Journal Article |
ZDB-ID | 1034239-4 |
ISSN | 1473-5687 ; 0954-691X |
ISSN (online) | 1473-5687 |
ISSN | 0954-691X |
DOI | 10.1097/MEG.0000000000002696 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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