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Letter
TIPSS plus extrahepatic collateral embolisation may decrease variceal rebleeding and post-TIPSS hepatic encephalopathy
  1. Lianhui Zhao1,2,
  2. Qiong Wu2,
  3. Qian Li1,2,
  4. Anbang Chen1,2,
  5. Yifu Xia1,2,
  6. Xiubin Sun3,
  7. Jidong Jia4,
  8. Shan Shan4,
  9. Guangchuan Wang1,2,3,
  10. Chunqing Zhang1,2
  1. 1 Gastroenterology, Cheeloo College of Medicine, Shandong University, Shandong Provincial Hospital, Jinan, Shandong, China
  2. 2 Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
  3. 3 Biostatistics, School of Public Health, Cheeloo Collage of Medicine, Shandong University, Jinan, Shandong, China
  4. 4 Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Guangchuan Wang, Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China; riverwang{at}126.com; Dr Shan Shan, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China; shanshan{at}ccmu.edu.cn

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We read with great interest the report in Gut by Hicks et al,1 which showed that transjugular intrahepatic portosystemic stent-shunt (TIPSS) was safe and efficacious in control of variceal rebleeding and refractory ascites, but carried a higher incidence of post-TIPSS hepatic encephalopathy (HE) than the current best estimations in 2020 British Society of Gastroenterology (BSG)-TIPSS guidelines.2 Interestingly, an adjuvant technique, simultaneous extrahepatic collateral embolisation (ECE) during TIPSS procedure may help to resolve this issue.

However, the clinical benefits of TIPSS plus ECE, including embolisation of gastroesophageal varices and spontaneous splenorenal shunts/gastrorenal shunts, are still controversial. Indeed, previous studies yielded inconsistent results in terms of short-term or long-term clinical outcomes.3–6 Therefore, we conducted a meta-analysis to compare the clinical outcomes of TIPSS±ECE.

Fifteen studies (online supplemental table 1) including 1408 patients with cirrhosis and variceal bleeding (1252 (88.9%) for secondary prophylaxis, 120 (8.5%) for acute treatment and 36 (2.6%) for other indications) retrieved from MEDLINE/PubMed, Cochrane Library, EMBASE and Web of Science and finally included in the meta-analysis. The results showed that TIPSS+ECE was associated with lower risks of rebleeding (OR 0.57; …

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Footnotes

  • Contributors LZ and QW conceived and designed the project. LZ and QW screened performed studies selection, data collection, calculation and quality assessment, independently. Disagreements were resolved through discussion or consensus or involvement of expert hepatologist/interventional radiologist (SS, GW) and an expert methodologist (XS). All authors approved the final version of the final letter.

  • Funding This work was supported by grants from the National Natural Science Foundation of China (82000569), the National Natural Science Foundation of China (81970533), the National Natural Science Foundation of China (82000566) and the Provincial Natural Science Foundation of Shandong, China (ZR2022MH010).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.