Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding: a systematic review and meta-analysis of controlled trials.

Détails

ID Serval
serval:BIB_5F53DAF17F73
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Early transjugular intrahepatic portosystemic shunt in cirrhotic patients with acute variceal bleeding: a systematic review and meta-analysis of controlled trials.
Périodique
European Journal of Gastroenterology and Hepatology
Auteur(s)
Deltenre P., Trépo E., Rudler M., Monescillo A., Fraga M., Denys A., Doerig C., Fournier N., Moreno C., Moradpour D., Bureau C., Thabut D.
ISSN
1473-5687 (Electronic)
ISSN-L
0954-691X
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
27
Numéro
9
Pages
e1-e9
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis ; Review
Publication Status: ppublish
Résumé
INTRODUCTION: There is conflicting evidence on the benefit of early transjugular intrahepatic portosystemic shunt (TIPSS) on the survival of patients with acute variceal bleeding (AVB).
AIM: To assess the effect of early TIPSS on patient prognosis.
MATERIALS AND METHODS: We carried out a meta-analysis of trials evaluating early TIPSS in cirrhotic patients with AVB.
RESULTS: Four studies were included. Early TIPSS was associated with fewer deaths [odds ratio (OR)=0.38, 95% confidence interval (CI)=0.17-0.83, P=0.02], with moderate heterogeneity between studies (P=0.15, I=44%). Early TIPSS was not significantly associated with fewer deaths among Child-Pugh B patients (OR=0.35, 95% CI=0.10-1.17, P=0.087) nor among Child-Pugh C patients (OR=0.34, 95% CI=0.10-1.11, P=0.074). There was no heterogeneity between studies in the Child-Pugh B analysis (P=0.6, I=0%), but there was a high heterogeneity in the Child-Pugh C analysis (P=0.06, I=60%). Early TIPSS was associated with lower rates of bleeding within 1 year (OR=0.08, 95% CI=0.04-0.17, P<0.001) both among Child-Pugh B patients, (OR=0.15, 95% CI=0.05-0.47, P=0.001) and among Child-Pugh C patients (OR=0.05, 95% CI=0.02-0.15, P<0.001), with no heterogeneity between studies. Early TIPSS was not associated with higher rates of encephalopathy (OR=0.84, 95% CI=0.50-1.42, P=0.5).
CONCLUSION: Cirrhotic patients with AVB treated with early TIPSS had lower death rates and lower rates of clinically significant bleeding within 1 year compared with patients treated without early TIPSS. Additional studies are required to identify the potential risk factors leading to a poor prognosis after early TIPSS in patients with AVB and to determine the impact of the degree of liver failure on the patient's prognosis.
Mots-clé
Controlled Clinical Trials as Topic, Esophageal and Gastric Varices/diagnosis, Esophageal and Gastric Varices/etiology, Gastrointestinal Hemorrhage/diagnosis, Gastrointestinal Hemorrhage/etiology, Humans, Liver Cirrhosis/complications, Liver Cirrhosis/diagnosis, Odds Ratio, Portasystemic Shunt, Transjugular Intrahepatic/adverse effects, Portasystemic Shunt, Transjugular Intrahepatic/mortality, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome
Pubmed
Web of science
Création de la notice
31/07/2015 8:23
Dernière modification de la notice
20/08/2019 14:17
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