Should transjugular intrahepatic portosystemic shunt be first-line therapy for preventing esophageal variceal rebleeding? A meta-analysis of clinical outcomes.
Introduction: According to Baveno VII guidelines, endoscopic band ligation (EBL) plus nonselective beta-blockers (NSBB) is first-line therapy for preventing esophageal variceal rebleeding, with transjugular intrahepatic portosystemic shunt (TIPS) being used in cases of treatment failure. Our study a...
| Publicado en: | Baylor University Medical Center Proceedings Vol. 38; no. 5; pp. 627 - 637 |
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| Autores principales: | , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Taylor & Francis Ltd
Sep2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=187310964&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 187310964 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 08998280 1XEP jtl: Baylor University Medical Center Proceedings issn: 08998280 maglogo: N pubinfo: dt: Sep2025 vid: 38 iid: 5 pid: 377 pub: Taylor & Francis Ltd place: Philadelphia, Pennsylvania artinfo: ui: 187310964 185856638 187310964 187310964 10.1080/08998280.2025.2514978 187310964 ppf: 627 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Should transjugular intrahepatic portosystemic shunt be first-line therapy for preventing esophageal variceal rebleeding? A meta-analysis of clinical outcomes. aug: au: Kareem, Rutaab Nadeem, Aimen Us Sehar, Noor Majid, Zuha Fatima, Tehniat Anwar, Rahma affil: Department of Internal Medicine, Mayo Hospital, Lahore, Pakistan sug: subj: Esophageal and Gastric Varices Surgery Gastrointestinal Hemorrhage Surgery Portasystemic Shunt, Surgical Ligation Endoscopy, Gastrointestinal Adrenergic beta-Antagonists Therapeutic Use Treatment Outcomes Mortality Human Systematic Review Meta Analysis Medline Embase Cochrane Library Odds Ratio Confidence Intervals ab: Introduction: According to Baveno VII guidelines, endoscopic band ligation (EBL) plus nonselective beta-blockers (NSBB) is first-line therapy for preventing esophageal variceal rebleeding, with transjugular intrahepatic portosystemic shunt (TIPS) being used in cases of treatment failure. Our study aimed to compare TIPS with EBL plus NSBB in terms of overall mortality and rate of variceal rebleeding. Methods: We conducted a comprehensive search on Medline, Google Scholar, Embase, and the Cochrane Library up to January 25, 2025. Randomized control trials (RCTs) comparing TIPS with EBL plus NSBB for variceal bleeding were included in the study. Results: Eight RCTs with 629 patients, 336 receiving TIPS and 293 receiving EBL + NSBB, were included. TIPS had significantly lower rates of variceal rebleeding (odds ratio 0.30, 95% confidence interval 0.19–0.49, P < 0.00001), all-cause rebleeding (P < 0.0001), total episodes of rebleeding (P < 0.0001), new/worsening ascites (P < 0.0001), and peritonitis (P = 0.01). No significant differences were found in mortality, sepsis/pneumonia, hepatic encephalopathy, or hepatocellular carcinoma. Conclusion: TIPS offers significant advantages over EBL plus NSBB in reducing variceal rebleeding and other complications but does not improve mortality. Further high-powered trials are needed to refine management strategies for variceal rebleeding in cirrhotic patients. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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