Efficacy and safety of transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma-A systematic review and meta-analysis.

IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY

Indian Journal of Gastroenterology Pub Date : 2024-12-01 Epub Date: 2024-08-10 DOI:10.1007/s12664-024-01646-7

Suprabhat Giri, Ankita Singh, Swati Das, Kateryna Strubchevska, Taraprasad Tripathy, Ranjan Kumar Patel, Marko Kozyk, Akash Roy

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引用次数: 0

Abstract

Background: Patients with hepatocellular carcinoma (HCC) and cirrhosis can present with features of severe portal hypertension, which can be worsened further by portal vein tumoral thrombosis (PVTT). Due to the technical difficulties and short survival of these patients, HCC was traditionally considered a relative contra-indication for transjugular intrahepatic portosystemic shunt (TIPS). However, there is an increasing body of evidence, mainly from China, supporting the use of TIPS in HCC. The present study aimed at analyzing the efficacy and safety of TIPS in patients with HCC.

Methods: From 2000 through May 2023, MEDLINE, Embase and Scopus were searched for studies analyzing the outcome of TIPS in HCC. Technical and clinical success, adverse events (AE) and mortality were the main outcomes assessed. With the use of a random effects model, the event rates were combined.

Results: Total 19 studies with 1498 patients were included in the final analysis. The pooled technical and clinical success rates with TIPS in HCC were 98.8% (98.0-99.7) and 94.1% (91.2-97.0), respectively. After TIPS, ascites was controlled in 89.2% (85.1-93.3) of the cases, while rebleeding was observed in 17.2% (9.4-25.0) of cases on follow-up. The pooled incidence of overall AE, serious AE and post-TIPS hepatic encephalopathy (HE) was 5.2% (2.5-7.9), 0.1% (0.0-0.4) and 25.1% (18.7-31.5), respectively. On follow-up, 11.9% (7.8-15.9) of the patients developed shunt dysfunction requiring re-intervention.

Conclusion: The present analysis supports the feasibility, safety and efficacy of TIPS in the management of portal hypertension in patients with HCC.

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肝细胞癌患者经颈静脉肝内门体分流术的有效性和安全性--系统回顾和荟萃分析。

背景：肝细胞癌（HCC）和肝硬化患者会出现严重的门静脉高压症状，而门静脉肿瘤血栓形成（PVTT）会进一步加重病情。由于这些患者的技术难度大、存活时间短，传统上认为 HCC 是经颈静脉肝内门体分流术（TIPS）的相对禁忌症。然而，越来越多的证据（主要来自中国）支持在 HCC 患者中使用 TIPS。本研究旨在分析 TIPS 在 HCC 患者中的有效性和安全性：方法：从 2000 年到 2023 年 5 月，在 MEDLINE、Embase 和 Scopus 上检索分析 TIPS 治疗 HCC 效果的研究。评估的主要结果包括技术和临床成功率、不良事件（AE）和死亡率。采用随机效应模型对事件发生率进行了综合分析：最终分析共纳入了 19 项研究，1498 名患者。TIPS治疗HCC的技术和临床成功率分别为98.8%（98.0-99.7）和94.1%（91.2-97.0）。TIPS术后，89.2%（85.1-93.3）的病例腹水得到控制，而17.2%（9.4-25.0）的病例在随访中出现再出血。总体AE、严重AE和TIPS后肝性脑病（HE）的汇总发生率分别为5.2%（2.5-7.9）、0.1%（0.0-0.4）和25.1%（18.7-31.5）。在随访中，11.9%（7.8-15.9）的患者出现分流功能障碍，需要再次进行干预：本分析支持 TIPS 治疗 HCC 患者门静脉高压的可行性、安全性和有效性。

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来源期刊

Indian Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

3.90

自引率

10.00%

发文量

期刊介绍： The Indian Journal of Gastroenterology aims to help doctors everywhere practise better medicine and to influence the debate on gastroenterology. To achieve these aims, we publish original scientific studies, state-of -the-art special articles, reports and papers commenting on the clinical, scientific and public health factors affecting aspects of gastroenterology. We shall be delighted to receive articles for publication in all of these categories and letters commenting on the contents of the Journal or on issues of interest to our readers.