Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: A meta‐analysis

Abstract

Adjunctive variceal embolization during TIPS procedures might be beneficial in the prevention of variceal rebleeding. However, given the heterogeneity of type of stents, embolic agents, type of varices, and indications of variceal embolization among studies, additional well-designed randomized, controlled trials with larger sample size and use of covered stents should be warranted to confirm these findings.

Early TIPS versus endoscopic therapy for secondary prophylaxis after management of acute esophageal variceal bleeding in cirrhotic patients: a meta‐analysis of randomized controlled trials

“…Another meta‐analysis by Qi et al evaluated the use of variceal embolization in combination with TIPS. This analysis included studies that compared variceal embolization alone versus TIPS plus variceal embolization and demonstrated that combination therapy was associated with a significantly lower incidence of variceal rebleeding but a similar incidence of shunt dysfunction, encephalopathy, and death.…”

Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of early variceal rebleeding after the initial control of bleeding: a systematic review and meta-analysis

“…A number of meta-analyses have examined endoscopic therapies, b-blockers, and transjugular intrahepatic portosystemic shunts with respect to control of variceal bleeding and re-bleeding [22][23][24][25]. However, few meta-analyses have compared vasoactive medications used for the management of acute variceal bleeding [12,[26][27][28], and to our knowledge none have evaluated the efficacy of vasoactive drugs on preventing re-bleeding.…”

Persistence of gastric or esophageal varices on final angiography increases transjugular intrahepatic portosystemic shunt revision rate after polytetrafluoroethylene-covered stent shunt creation

“…At our knowledge, no other studies showed such data. This could be explained by the fact that oesophageal or gastric post-TIPS varices create a competitive flow, leading to more risk of stent thrombosis or stenosis because of lower flow into the TIPS (38,39). Indeed, persistent flow into varices can be responsible for hemodynamic steal from the PV leading to slower flow into the TIPS shunt and potentially higher risk of in-stent thrombosis.…”