Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis
Background and Aim. Upper gastrointestinal bleeding is a threat to patients with gastric varices (GVs). Previous studies have concluded that both transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are effective treatments for patients...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2020/5143013 |
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| author | Zi Wen Wang Jin Chao Liu Fang Zhao Wen Guang Zhang Xu Hua Duan Peng Fei Chen Si Fu Yang Hong Wei Li Fu Wen Chen Hong Sheng Shi Jian Zhuang Ren |
| author_facet | Zi Wen Wang Jin Chao Liu Fang Zhao Wen Guang Zhang Xu Hua Duan Peng Fei Chen Si Fu Yang Hong Wei Li Fu Wen Chen Hong Sheng Shi Jian Zhuang Ren |
| author_sort | Zi Wen Wang |
| collection | DOAJ |
| description | Background and Aim. Upper gastrointestinal bleeding is a threat to patients with gastric varices (GVs). Previous studies have concluded that both transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are effective treatments for patients with GV. We aimed to compare the efficiency and outcomes of these two procedures in GV patients through meta-analysis. Methods. The PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched using the keywords: GV, bleeding, TIPS, and BRTO to identify relevant randomized controlled trials and cohort studies. The overall survival (OS) rate, imminent haemostasis rate, rebleeding rate, technical success rate, procedure complication rate (hepatic encephalopathy and aggravated ascites), and Child-Pugh score were evaluated. Randomized clinical trials and cohort studies comparing TIPS and BRTO for GV due to portal hypertension were included in our meta-analysis. Two independent reviewers performed data extraction and assessed the study quality. A meta-analysis was performed to calculate risk ratios (RRs), mean differences (MDs), and 95% CIs using random effects models. Results. A total of nine studies fulfilled the inclusion criteria. There was a significant difference between TIPS and BRTO in the OS rate (RR, 0.81 (95% CI, 0.66 to 0.98); P=0.03) and rebleeding rate (RR, 2.61 (95% CI, 1.75 to 3.90); P<0.00001). TIPS had a higher incidence rate of hepatic encephalopathy (RR, 16.11 (95% CI, 7.13 to 36.37); P<0.00001). There was no significant difference between TIPS and BRTO in the immediate haemostasis rate (RR, 0.99 (95% CI, 0.89 to 1.10); P=0.84), technical success rate (RR, 1.06 (95% CI, 0.98 to 1.16); P=0.16), aggravated ascites rate (RR, 0.60 (95% CI, 0.33 to 1.09); P=0.10), or Child-Pugh change (MD, 0.22 (95% CI, −0.21 to 0.65); P=0.31). Conclusions. In this meta-analysis, BRTO brought more benefits to patients, with a higher OS rate and lower rebleeding rate. BRTO is a feasible method for GVB. |
| format | Article |
| id | doaj-art-9fa3cb77f3684121934153996ee6a9e9 |
| institution | OA Journals |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-9fa3cb77f3684121934153996ee6a9e92025-08-20T02:20:09ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972020-01-01202010.1155/2020/51430135143013Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-AnalysisZi Wen Wang0Jin Chao Liu1Fang Zhao2Wen Guang Zhang3Xu Hua Duan4Peng Fei Chen5Si Fu Yang6Hong Wei Li7Fu Wen Chen8Hong Sheng Shi9Jian Zhuang Ren10Radiology Intervention Department, Puyang Oilfield General Hospital, Puyang, ChinaRadiology Intervention Department, Puyang Oilfield General Hospital, Puyang, ChinaRadiology Intervention Department, Puyang Oilfield General Hospital, Puyang, ChinaRadiology Intervention Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaRadiology Intervention Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaRadiology Intervention Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaRadiology Intervention Department, Puyang Oilfield General Hospital, Puyang, ChinaRadiology Intervention Department, Puyang Oilfield General Hospital, Puyang, ChinaRadiology Intervention Department, Puyang Oilfield General Hospital, Puyang, ChinaRadiology Intervention Department, Puyang Oilfield General Hospital, Puyang, ChinaRadiology Intervention Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaBackground and Aim. Upper gastrointestinal bleeding is a threat to patients with gastric varices (GVs). Previous studies have concluded that both transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are effective treatments for patients with GV. We aimed to compare the efficiency and outcomes of these two procedures in GV patients through meta-analysis. Methods. The PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched using the keywords: GV, bleeding, TIPS, and BRTO to identify relevant randomized controlled trials and cohort studies. The overall survival (OS) rate, imminent haemostasis rate, rebleeding rate, technical success rate, procedure complication rate (hepatic encephalopathy and aggravated ascites), and Child-Pugh score were evaluated. Randomized clinical trials and cohort studies comparing TIPS and BRTO for GV due to portal hypertension were included in our meta-analysis. Two independent reviewers performed data extraction and assessed the study quality. A meta-analysis was performed to calculate risk ratios (RRs), mean differences (MDs), and 95% CIs using random effects models. Results. A total of nine studies fulfilled the inclusion criteria. There was a significant difference between TIPS and BRTO in the OS rate (RR, 0.81 (95% CI, 0.66 to 0.98); P=0.03) and rebleeding rate (RR, 2.61 (95% CI, 1.75 to 3.90); P<0.00001). TIPS had a higher incidence rate of hepatic encephalopathy (RR, 16.11 (95% CI, 7.13 to 36.37); P<0.00001). There was no significant difference between TIPS and BRTO in the immediate haemostasis rate (RR, 0.99 (95% CI, 0.89 to 1.10); P=0.84), technical success rate (RR, 1.06 (95% CI, 0.98 to 1.16); P=0.16), aggravated ascites rate (RR, 0.60 (95% CI, 0.33 to 1.09); P=0.10), or Child-Pugh change (MD, 0.22 (95% CI, −0.21 to 0.65); P=0.31). Conclusions. In this meta-analysis, BRTO brought more benefits to patients, with a higher OS rate and lower rebleeding rate. BRTO is a feasible method for GVB.http://dx.doi.org/10.1155/2020/5143013 |
| spellingShingle | Zi Wen Wang Jin Chao Liu Fang Zhao Wen Guang Zhang Xu Hua Duan Peng Fei Chen Si Fu Yang Hong Wei Li Fu Wen Chen Hong Sheng Shi Jian Zhuang Ren Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis Canadian Journal of Gastroenterology and Hepatology |
| title | Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis |
| title_full | Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis |
| title_fullStr | Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis |
| title_full_unstemmed | Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis |
| title_short | Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis |
| title_sort | comparison of the effects of tips versus brto on bleeding gastric varices a meta analysis |
| url | http://dx.doi.org/10.1155/2020/5143013 |
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