Clinical efficacy of transjugular intrahepatic portosystemic shunt created through left or right branches of the portal vein: A meta-analysis.

BACKGROUND AND AIM

Transjugular intrahepatic portosystemic shunt (TIPS) is a technique successfully used to treat portal hypertension and its complications. However, the choice of the branch, left (L) or right (R), of the portal vein resulting in a better outcome is still under debate. Therefore, this meta-analysis aims to evaluate which branch has a better curative effect on patients treated with TIPS.

METHODS

PubMed, EMBASE, Web of science, Cochrane Library databases, Wanfang database and CBM were used for our search in October 2019 and updated in June 2021. The following parameters were used in evaluation: overall mortality, hepatic encephalopathy, shunt dysfunction, variceal rebleeding and rate of postoperative ascites.

RESULTS

There were seven studies included. The sample size was 1940. A lower risk of mortality was observed in TIPS-L-treated patients compared with TIPS-R-treated ones (OR ​= ​0.65, 95% CI ​= ​0.50-0.85, p ​= ​0.002). A lower risk of shunt dysfunction was observed in TIPS-L-treated patients compared with TIPS-R-treated ones (OR ​= ​0.53, 95% CI ​= ​0.33-0.87, p ​= ​0.01). And the TIPS-L group had a significantly higher hepatic encephalopathy-free rate than the TIPS-R group (OR ​= ​0.59, 95% CI ​= ​0.44-0.78, p ​= ​0.0002). However, the rate of rebleeding (OR ​= ​0.75, 95% CI ​= ​0.55-1.03, p ​= ​0.07) and incidence of postoperative ascites (OR ​= ​1.14, 95% CI ​= ​0.86-1.51, p ​= ​0.38) was not statistically significant between the two groups.

CONCLUSIONS

Based on the currently available evidence, the technique of TIPS through the left branch of the portal vein can significantly reduce the occurrence of overall postoperative mortality, hepatic encephalopathy and shunt dysfunction.