PDF(Pubmed)
Abstract：
UNASSIGNED: The role of variceal embolization (VE) during transjugular intrahepatic portosystemic shunt (TIPS) creation for preventing gastroesophageal variceal rebleeding remains controversial. Therefore, we performed a meta-analysis to compare the incidence of variceal rebleeding, shunt dysfunction, encephalopathy, and death between patients treated with TIPS alone and those treated with TIPS in combination with VE.
UNASSIGNED: We performed a literature search using PubMed, EMBASE, Scopus, and Cochrane databases for all studies comparing the incidence of complications between TIPS alone and TIPS with VE. The primary outcome was variceal rebleeding. Secondary outcomes include shunt dysfunction, encephalopathy, and death. Subgroup analysis was performed based on the type of stent (covered vs. bare metal). The random-effects model was used to calculate the relative risk (RR) with the corresponding 95% confidence intervals (CIs) of outcome. A P value < 0.05 was considered statistically significant.
UNASSIGNED: Eleven studies with a total of 1,075 patients were included (597: TIPS alone and 478: TIPS plus VE). Compared to the TIPS alone, the TIPS with VE had a significantly lower incidence of variceal rebleeding (RR: 0.59, 95% CI: 0.43 - 0.81, P = 0.001). Subgroup analysis revealed similar results in covered stents (RR: 0.56, 95% CI: 0.36 - 0.86, P = 0.008) but there was no significant difference between the two groups in the subgroup analysis of bare stents and combined stents. There was no significant difference in the risk of encephalopathy (RR: 0.84, 95% CI: 0.66 - 1.06, P = 0.13), shunt dysfunction (RR: 0.88, 95% CI: 0.64 - 1.19, P = 0.40), and death (RR: 0.87, 95% CI: 0.65 - 1.17, P = 0.34). There were similarly no differences in these secondary outcomes between groups when stratified according to type of stent.
UNASSIGNED: Adding VE to TIPS reduced the incidence of variceal rebleeding in patients with cirrhosis. However, the benefit was observed with covered stents only. Further large-scale randomized controlled trials are warranted to validate our findings.
UNASSIGNED: We performed a literature search using PubMed, EMBASE, Scopus, and Cochrane databases for all studies comparing the incidence of complications between TIPS alone and TIPS with VE. The primary outcome was variceal rebleeding. Secondary outcomes include shunt dysfunction, encephalopathy, and death. Subgroup analysis was performed based on the type of stent (covered vs. bare metal). The random-effects model was used to calculate the relative risk (RR) with the corresponding 95% confidence intervals (CIs) of outcome. A P value < 0.05 was considered statistically significant.
UNASSIGNED: Eleven studies with a total of 1,075 patients were included (597: TIPS alone and 478: TIPS plus VE). Compared to the TIPS alone, the TIPS with VE had a significantly lower incidence of variceal rebleeding (RR: 0.59, 95% CI: 0.43 - 0.81, P = 0.001). Subgroup analysis revealed similar results in covered stents (RR: 0.56, 95% CI: 0.36 - 0.86, P = 0.008) but there was no significant difference between the two groups in the subgroup analysis of bare stents and combined stents. There was no significant difference in the risk of encephalopathy (RR: 0.84, 95% CI: 0.66 - 1.06, P = 0.13), shunt dysfunction (RR: 0.88, 95% CI: 0.64 - 1.19, P = 0.40), and death (RR: 0.87, 95% CI: 0.65 - 1.17, P = 0.34). There were similarly no differences in these secondary outcomes between groups when stratified according to type of stent.
UNASSIGNED: Adding VE to TIPS reduced the incidence of variceal rebleeding in patients with cirrhosis. However, the benefit was observed with covered stents only. Further large-scale randomized controlled trials are warranted to validate our findings.
摘要：
■经颈静脉肝内门体分流术(TIPS)预防胃食管静脉曲张再出血的作用仍存在争议。因此,我们进行了一项荟萃分析，以比较静脉曲张再出血的发生率，分流功能障碍,脑病,仅接受TIPS治疗的患者与接受TIPS联合VE治疗的患者之间的死亡。
■我们使用PubMed进行了文献检索，EMBASE,Scopus,和Cochrane数据库，用于比较单独TIPS和有VE的TIPS的并发症发生率的所有研究。主要结果是静脉曲张再出血。次要结果包括分流功能障碍，脑病,和死亡。根据支架类型进行亚组分析(覆盖与裸金属)。随机效应模型用于计算相对风险(RR)和相应的95%置信区间(CI)。P值<0.05被认为是统计学上显著的。
■纳入了11项研究，共1,075例患者（597：单独TIPS和478：TIPS加VE）。与单独的TIPS相比，有VE的TIPS患者静脉曲张再出血的发生率显著降低(RR:0.59,95%CI:0.43~0.81,P=0.001).亚组分析显示，覆膜支架的结果相似（RR：0.56，95％CI：0.36-0.86，P=0.008），但两组在裸支架和联合支架的亚组分析中没有显着差异。脑病风险差异无统计学意义(RR:0.84,95%CI:0.66-1.06,P=0.13),分流功能障碍（RR：0.88，95%CI：0.64-1.19，P=0.40），和死亡（RR：0.87，95%CI：0.65-1.17，P=0.34）。当根据支架类型进行分层时，组间的这些次要结果也没有类似差异。
■在TIPS中添加VE可降低肝硬化患者静脉曲张再出血的发生率。然而,仅在有覆盖支架的情况下观察到获益.需要进一步的大规模随机对照试验来验证我们的发现。
■我们使用PubMed进行了文献检索，EMBASE,Scopus,和Cochrane数据库，用于比较单独TIPS和有VE的TIPS的并发症发生率的所有研究。主要结果是静脉曲张再出血。次要结果包括分流功能障碍，脑病,和死亡。根据支架类型进行亚组分析(覆盖与裸金属)。随机效应模型用于计算相对风险(RR)和相应的95%置信区间(CI)。P值<0.05被认为是统计学上显著的。
■纳入了11项研究，共1,075例患者（597：单独TIPS和478：TIPS加VE）。与单独的TIPS相比，有VE的TIPS患者静脉曲张再出血的发生率显著降低(RR:0.59,95%CI:0.43~0.81,P=0.001).亚组分析显示，覆膜支架的结果相似（RR：0.56，95％CI：0.36-0.86，P=0.008），但两组在裸支架和联合支架的亚组分析中没有显着差异。脑病风险差异无统计学意义(RR:0.84,95%CI:0.66-1.06,P=0.13),分流功能障碍（RR：0.88，95%CI：0.64-1.19，P=0.40），和死亡（RR：0.87，95%CI：0.65-1.17，P=0.34）。当根据支架类型进行分层时，组间的这些次要结果也没有类似差异。
■在TIPS中添加VE可降低肝硬化患者静脉曲张再出血的发生率。然而,仅在有覆盖支架的情况下观察到获益.需要进一步的大规模随机对照试验来验证我们的发现。
