A Meta-analysis Comparing Covered Stents With Different Diameter In Transjugular Intrahepatic Portosystemic Shunt(TIPS) For The Treatment Of Portal Hypertension In Patients

Objective: To systematically evaluate the effectiveness and safety of using covered stents with different diameter in Transjugular Intrahepatic Portosystemic Shunt(TIPS)for the treatment of portal hypertension in patients with cirrhosis using Meta-analysis,to provide a better reference for the choice of stent of cirrhotic portal hypertension treatment and the prevention of its postoperative complications.Methods: Using computer to search major databases including PubMde,Cochrane Library,Embase,CNKI,CQVIP,and Wanfang Data for documents since the establishment of the databases till December 31,2019,with English keywords such as ‘Portasystemic Shunt,Transjugular Intrahepatic',‘TIPSS',‘Transjugular Intrahepatic Portasystemic Shunt',‘10mm',‘8mm',‘Stent diameter',‘covered' and the corresponding Chinese keywords.Two independent researchers screened the retrieved documents in strict accordance with the pre-established inclusion and exclusion criteria,used Jadad Score to evaluate the quality of selected randomized controlled trial(RCT)documents and NOS Scale to evaluate the quality of the included cohort studies then extracted related data.The study outcome was postoperative hepatic encephalopathy,postoperative re-hemorrhage,stent dysfunction,and postoperative death.The data related to transjugular intrahepatic portosystemic shunt(TIPS)using 8mm and 10 mm stent with different diameter was analyzed by RevMan5.3 software.Results: Twelve studies were finally included with a total of 1,096 patients.They were divided into the experimental group(8mm stent group)with 625 cases and the control group(10mm stent group)with 471 cases.Meta-analysis results showed that: 1.When ‘hepatic encephalopathy after TIPS' was the outcome indicator,the 8mm stent group was lower than the 10 mm stent group and there was a statistical difference(RR value = 0.79,95% CI [0.66,0.94],P = 0.008).2.When ‘postoperative re-hemorrhage' was the outcome indicator,there was no significant statistical difference between the 8mm stent group and the 10 mm stent group(RR value = 1.22,95% CI [0.79,1.89],P = 0.36).3.When ‘stent dysfunction after TIPS' was the outcome indicator,there was no significant statistical difference between the 8mm stent group and the 10 mm stent group(RR value = 1.42,95% CI [0.96,2.09],P = 0.08).4.When ‘postoperative death' was the outcome indicator,there was no significant statistical difference between the 8mm stent group and the 10 mm stent group(RR value = 0.92,95% CI [0.57,1.49],P = 0.75).Conclusions: TIPS for the treatment of portal hypertension in patients with cirrhosis,1)using 8mm diameter stent is better than 10 mm diameter stent as the postoperative hepatic encephalopathy risk is lower;2)In terms of postoperative re-hemorrhage,stent dysfunction and postoperative death,there is no significant difference between using an 8mm diameter stent and a 10 mm diameter stent.