Transjugular Intrahepatic Portosystemic Shunt Versus Endoscopic Therapy In Treating Variceal Rebleeding In Hepatocirrhosis Patients : A Meta-Analysis

Aim:The aim of this meta-analysis is to compare the transjugular intrahepatic portosystemic shunt with endoscopic therapy(including EVL\EIS\EHI)in treating variceal rebleeding in hepatocirrhosis patients and to confirm their effectiveness and safety.Methods:After the search strategy was established,all relevant studies comparing transjugular intrahepatic portosystemic shunt with endoscopic therapy in treating variceal rebleeding in hepatocirrhosis patients from Pubmed,Cochrane Library,Embase,CNKI,Wanfang data and so on were searched and checked by inclusion&exclusion criteria extending up to June 2018.The final statistical analysis was executed with REVMAN 5.3.Results:6 high quality RCTs were included in our study,involving 270 cases in TIPS and261 cases in ET.Our study suggested that:(1)TIPS group had a lower rate of variceal rebleeding(RR=0.32,95%CI:0.18?0.55,P<0.0001)than endoscopic therapy group;(2)TIPS and ET groups were little different in the term of total mortality(RR=0.90,95%CI:0.69?1.18,P=0.45),while the mortality related to rebleeding was lower in the TIPS group than ET group(RR=0.24,95%CI:0.11?0.53,P=0.0004);(3)The encephalopathy ratewas little different in both groups(RR=1.44,95%CI : 0.91?2.28,P=0.12);(4)the total in-hospital time was equal in both groups(WMD=2.29,95%CI:-0.89?5.47,P=0.16).Conclusion:In treating variceal rebleeding in hepatocirrhosis patients,TIPS may be more effective than ET especially in reducing the rate of variceal rebleeding and the deaths caused by variceal rebleeding.However,there were no significant differences in HE incidents and total in-hospital time between TIPS and endoscopic therapy.