Systematic review
Gastrointestinal imaging
Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

https://doi.org/10.1016/j.diii.2020.11.004Get rights and content
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Highlights

  • A meta-analysis was performed to compare the clinical efficacy of TIPS using 8 mm covered stents to that using 10 mm diameter covered stents in patients with liver cirrhosis.

  • The 8 mm covered stent group had greater one-year (odds ratio [OR], 2.88; P = 0.003) and three-year overall survival (OR, 1.81; P = 0.04) and lower hepatic encephalopathy rate (OR, 0.69; P = 0.04) compared to 10 mm covered stent group.

  • No significant differences in variceal rebleeding (OR, 0.80; P = 0.67) was found between the two stents but shunt dysfunction rate was lower in 10 mm covered stent group (OR, 2.26; P = 0.003).

Abstract

Purpose

The purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8 mm vs. 10 mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS).

Materials and methods

Four databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8 mm covered stents and those with 10 mm covered stents.

Results

Five eligible studies were selected, which included 489 patients (316 men, 173 women). The 8 mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P = 0.003) and (OR, 1.81; P = 0.04) and lower hepatic encephalopathy (OR, 0.69; P = 0.04) compared with 10 mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P = 0.67). However, shunt dysfunction was lower in 10 mm covered stent group (OR, 2.26; P = 0.003).

Conclusions

Our results suggest that the use of 8 mm covered stents should be preferred to that of 10 mm covered stents for TIPS placement when portal pressure is frequently monitored.

Keywords

Hepatic encephalopathy
Portosystemic shunt
Transjugular intrahepatic (TIPS)
Overall survival
Stents diameter
Meta-analysis

Abbreviations

CI
confidence interval
HE
hepatic encephalopathy
HR
hazard ratio
OR
odds ratio
OS
overall survival
PRISMA-P
Systematic Review and Meta-Analysis Protocols
NOS
Newcastle–Ottawa scale
PTFE-covered
polytetrafluoroethylene-covered
RCT
randomized controlled trial
RR
risk ratio
TIPS
transjugular intrahepatic portosystemic shunt

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1

These authors contributed equally to this work.