| Objective: The aim of this meta-analysis was to compare the transjugular intrahepatic portosystemic shunt with endoscopic therapy(including EVL ? EIS ? cyanoacrylate injection)in the secondary prophylaxis of variceal rebleeding in hepatocirrhotic patients,to confirm which is more effective and secure.Methods : After the search strategy was established,all relevant studies that compared transjugular intrahepatic portosystemic shunt with endoscopic therapy in the secondary prophylaxis of variceal rebleeding in cirrhotic patients from Medline,Embase,Cochrane Central Trials,CBM,CNKI,Wanfang Data and Vip were searched and checked by inclusion criteria and exclusion criteria extending up to June 2016,the references which were lated to our theme of the articles were also searched and checked.The data was extracted independently by two members of us,and the disagreements were resolved by discussions with the third party.The following items were collected from the selected literatures:first anthor,year of publication,country,language,the number of patients,Child-Pugh Class,Treatment,variceal rebleeding,mortality,hospital time,encephalopathy and so on.Then,quality assessment of the selected trails was performed with the Cochrane “ Risk of bias ” assessment tool according to selection bias,performance bias,detection bias,attrition bias,reporting bias and so on.The final result was made out to two graphs by using the statistical software Revman 5.3.At last,statistical analysis was executed with Revman 5.3,for studies in the absence of heterogeneity,a fixed effect model was used for the meta-analysis;otherwise,a random effect model was adopted.The bias for each of the groups was assessed by using a funnel plot.Results: 16 RCTs involving 1163 patients were included.(1)The recurrent total variceal rebleeding rate was significantly lower in the TIPS group than in the endoscopic group(RR=0.43,95%CI:0.36~0.52,P<0.00001);the 1-(RR=0.43,95%CI:0.27—0.68,P=0.0003),2-year probability of variceal rebleeding rate(RR=0.51,95%CI:0.32—0.79,P=0.003)was lower in the TIPS group than in the endoscopic group;(2)TIPS and endoscopic group was equal in the respect of the mortality(RR=1.04,95%CI:0.86~1.27,P=0.66).In the subgroup analysis of mortality according to the endoscopic type?stent type ?medicine combination?region,there was no difference between the two groups;While the mortality related rebleeding was lower in the TIPS group than the endoscopic group(RR=0.34,95%CI:0.18~0.65,P=0.001);(3)The encephalopathy rate was significantly higher in the TIPS group than the endoscopic group(RR=1.58,95%CI:1.31~1.91,P<0.00001),while in the subgroup analysis according to the stent type,the encephalopathy rate of bare TIPS group was higher than the endoscopic group(RR=1.75,95%CI:1.31~2.34,P=0.0002),and it was equal between covered TIPS group and endoscopic group(RR=0.98,95%CI:0.6~1.6,P=0.94);(4)Other aspects:In the respect of the TIPS dysfunction,the 1-,2-,3-,4-year probability of bare TIPS dysfunction was 61%~75%?23%~93.5%?93.5%?89%,and the 1-,2-year probability of covered TIPS dysfunction was 8.3%?28.7%;The transfusion units of RBC was less in the TIPS group than the endoscopic group(WMD=-1.95,95%CI:-3.34~-0.56,P=0.006);The time in hospital was shorter in the endoscopic group than the TIPS group(WMD=1.86,95%CI:1.12~2.59,P<0.00001)?Conclusion:In terms of variceal rebleeding rate,the 1-and 2-year probability of variceal rebleeding rate,the mortality related rebleeding and the transfusion units of RBC,TIPS placement is superior to endoscopic treatment for the secondary prophylaxis of variceal rebleeding in cirrhotic patients.Furthermore the encephalopathy rate of covered TIPS and survival did not differ to the endoscopic treatment.TIPS placement is superior to endoscopic treatment for secondary prevention of variceal rebleeding. |
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