Transjugular Intrahepatic Portosystemic Shunt Versus Endoscopic Treatment For Cirrhotic Variceal Bleeding:A Meta Analysis

Objective:To compare the efficacy of transjugular intrahepatic portosystemic shunt with endoscopic treatment in the treatment of liver cirrhosis with esophagogastric variceal bleeding.Methods:Formulating the retrieval strategy,a comprehensive search was conducted in Pubmed,Embase,Cochrane database,The CNKI,WANFANG data and VIPdatabase.The scope of the search is from the establishment of the database to September,2019.The checked-out articles were further screened in strict accordance with the inclusion and exclusion criteria drawn up in advance.After screening,the basic information of the literature,Child-Pugh related score(A/B/C),treatment methods,rebleeding rate,mortality,incidence of hepatic encephalopathy,incidence of new or worsening ascites,volume of erythrocytes transfusion,liver transplantation rate,varicose vein occlusion rate and other related data were extracted and sorted out.Finally,Revman 5.3 software is selected for data analysis.Results: A total of 22 randomized controlled trials were retrieved by the above methods,and the total number of cases included was 1589.The results showed that the total bleeding rate of TIPS group was better than that of ET group(OR=0.27,95%CI :0.22,0.34,P<0.00001),1-year rebleeding rate(OR=0.27,95%CI:0.20,0.36,P<0.00001),2-year rebleeding rate(OR=0.28,95%CI:0.20,0.39,P<0.00001),indicating that TIPS in terms of rebleeding rate,regardless of the total rebleeding rate,the rate of rebleeding in 1 year and 2 years was lower than that in endoscopic treatment group.In terms of mortality,there was no significant difference between TIPS and ET groups(OR=0.97,95%CI :0.77~1.21,P=0.76),but hemorrhage-related mortality in TIPS group was less than ET group(OR=0.31,95%CI :0.19~0.50,P<0.00001).In terms of the incidence of hepatic encephalopathy,the incidence of hepatic encephalopathy in TIPS group was higher than ET group(OR=1.69,95%CI :1.35~2.12,P<0.00001).The formation rate of new or worsening ascites in TIPS group was less than ET group(OR=0.48,95%CI :0.23~0.98,P=0.04).In terms of orthotopic liver transplantation rate,there was no significant difference between the two groups(OR=0.86,95%CI :0.46~1.63,P=0.65),and there was no significant difference in average hospital stay between the two groups(MD=1.52,95%CI :-0.43~3.48,P=0.13).Finally,the amount of suspended erythrocyte transfusion during hospitalization in TIPS group was lower than ET group(MD=-1.95,95%CI :-3.34~-0.56,P=0.006).We also analyzed some outcome indicators according to stent type,endoscopic treatment,Child-Pugh grade,location of bleeding point,single-center or multi-center study,and whether combined with non-selective β-blockers.The patency rate of long-term stent is different with different stent types,and the covered stent is better than the bare metal stent.Different endoscopic treatment methods,varicose vein elimination rate is different,endoscopic sclerosing agent treatment shows a comparative advantage.Conclusion : TIPS is superior to ET,in rebleeding rate,hemorrhage-related mortality rate,incidence of new or worsening ascites and suspension erythrocyte transfusion,but there is no significant difference in mortality,orthotopic liver transplantation rate and average hospital stay.The incidence of hepatic encephalopathy is higher,but in recent years,the use of covered stents makes TIPS and ET have the same incidence of hepatic encephalopathy.