Transjugular Intrahepatic Portosystemic Shunt for Portal Vein Cavernous Transformation: A Systematic Review and Single-Arm Meta-Analysis

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is technically challenging in the treatment of portal vein cavernous transformation (PVCT), and there is no high-quality evidence regarding whether it is an option for patients with PVCT. We carried out a systematic review and meta-analysis to assess the feasibility and safety of TIPS for PVCT. Methods: Systematic search of PubMed, Chinese National Knowledge Infrastructure (CNKI) database, Cochrane Library, Embase, and Wanfang database through December 2021 for appropriate studies reporting efficacy and safety in patients with PVCT undergoing TIPS. The main outcome included the technical success rate, postoperative rebleeding rate, postoperative hepatic encephalopathy rate, stent patency rate, preoperative, and postoperative portal pressure. Results: Ten studies, including 292 patients were included. Our results showed that TIPS was technically successful in 82.97% (95% confidence interval [CI]: 77.14%–88.41%, p = 0.297) with low heterogeneity (I² = 18.39%, p = 0.279). Postoperative rebleeding occurred in 9.56% (95% CI: 4.55%–16.77%, p = 0.073) with moderate heterogeneity (I² = 46.45%, p = 0.06). Postoperative hepatic encephalopathy occurred in 18.55% (95% CI: 9.23%–27.05%, p = 0.343) with moderate heterogeneity (I² = 48.62%, p = 0.049). Stent patency during follow-up was in 78.43% (95% CI: 70.74%–85.20%, p = 0.805) with low heterogeneity (I² = 0%, p = 0.654). Postoperative portal pressure significantly reduced (WMD = 12.79 mm Hg, 95% CI: 12.09–13.48 mm Hg, p < 0.00001) with high heterogeneity (I² = 61.4%, p = 0.02). Both Begg test and funnel plot showed that there was no significant publication bias. Conclusions: TIPS is feasible and safe in patients with PVCT and PVCT should not be considered an absolute contraindication to TIPS.