A meta-analysis of transjugular intrahepatic portosystemic shunt with or without embolization for esophageal and gastric variceal bleeding in decompensated liver cirrhosis.

Abstract

Background: This study aimed to evaluate whether transjugular intrahepatic portosystemic shunt (TIPS) combined with embolization could further improve efficacy for patients with decompensated liver cirrhosis complicated with esophageal and gastric variceal bleeding.

Methods: We searched PubMed, Web of Science, Embase, and Cochrane Library, for all relevant randomized controlled trials and cohort studies up to March 2025. Statistical results were evaluated using risk ratios and 95% confidence intervals (CIs).

Results: A total of 14 studies involving 3079 patients were included. The statistical results showed that the rebleeding rate in the TIPS combined with embolization group was lower than that in the TIPS alone group (risk ratios = 0.67; 95% CI = 0.57-0.79; P  < 0.001), and the same result was observed only in the subgroup of patients with gastric variceal bleeding (risk ratios = 0.50; 95% CI = 0.34-0.74; P  < 0.001). There was no significant difference between the groups in patients with isolated esophageal variceal bleeding (risk ratios = 0.83; 95% CI = 0.51-1.35; P  = 0.46). In addition, the incidence of hepatic encephalopathy in the TIPS combined with embolization group was also lower than that in the TIPS alone group (risk ratios = 0.82; 95% CI = 0.73-0.91; P  < 0.001), but there was no significant difference in survival rate (risk ratios = 1.00; 95% CI = 0.97-1.03; P  = 0.94).

Conclusion: Compared with TIPS alone, the combined treatment showed a trend toward lower rebleeding and hepatic encephalopathy, yet survival appeared similar between the two groups.