The Efficacy And Safety Of Transjugular Intrahepatic Portosystemic Shunt Versus Endoscopic Therapy In The Secondary Prophylaxis Of Variceal Rebleeding In Patients With Cirrhosis:A Meta Analysis

Objective:In order to compare the clinical effects of transjugular intrahepatic portosystemic shunt(TIPS) versus endoscopic therapy(ET) in reducing variceal rebleeding in patients with cirrhosis.Methods:Eligible articles published before July 2015 were identified by searches of electronic database including Pub Med、Embase、Web of science、The Cochrane Library、Medline、CBM、Wang Fang data、CNKI.All randomized trials that compared transjugular intrahepatic portosystemic shunt versus endoscopy therapy for prevention of variceal rebleeding in patients with cirrhosis were be included.Statistical analysis was performed with Review Manager 5.2.Results: Sixteen high quality RCTs were recruited in our study,involving 659 cases in TIPS and 644 cases in ET.The meta-analysis showed that compared with ET,the TIPS group had a lower incidence of variceal rebleeding and deaths due to rebleeding(RR=0.41,95%CI: 0.35~0.49,P<0.00001;RR=0.38,95%CI:0.24~0.59,P<0.0001).But TIPS group had an increased rate of posttreatment encephalopathy(RR=1.62,95%CI:1.35 ~ 1.95, P<0.00001).There were no significant differences between the tow groups as to deaths due to all causes and hospitalization days(RR=1.01,95%CI:0.83~1.23,P=0.93;MD=0.84,95%CI:-1.33~3.02,P=0.45).Conclusions: In the aspect of prevention variceal rebleeding,TIPS is more effect than ET,and sometimes remains the first choice to prevent rebleeding except that TIPS is worse than ET for posttreatment encephalopathy. At some times,TIPS can be the priority selection to prevent variceal rebleeding.