Endoscopic therapy（ET） is most common method for preventing variceal bleeding in cirrhosis, but the outcomes are not perfect. Recently, transjugular intrahepatic portosystemic shunt（TIPS） is introduced into clinic...Endoscopic therapy（ET） is most common method for preventing variceal bleeding in cirrhosis, but the outcomes are not perfect. Recently, transjugular intrahepatic portosystemic shunt（TIPS） is introduced into clinical practice. However, the beneficial effects of TIPS compared to ET on cirrhotic patients is unknown. The aim of this study was to evaluate and compare the effects of TIPS with those of the most frequently used ET for prevention of variceal rebleeding（VRB） in liver cirrhosis. The PubMed, EMBASE, and Cochrane Library databases were searched from inception to February 2017. The primary study outcomes included the incidence of VRB, all-cause mortality, bleeding-related death, and the incidence of post-treatment hepatic encephalopathy（PTE）. The odds ratios（ORs） with 95% confidence intervals（CI） were pooled for dichotomous variables. Subgroup analyses were performed. Twenty-four studies were eligible and they included 1120 subjects treated with TIPS and 1065 subjects treated with ET. Although there was no significant difference in survival and PTE, TIPS was superior to ET in decreasing the incidence of VRB（OR=0.27; 95% CI, 0.19–0.39, P〈0.00001）, and decreasing the incidence of bleeding-related death（OR=0.21; 95% CI, 0.13–0.32, P〈0.00001）. Subgroup analysis found a lower mortality（OR=0.48; 95% CI, 0.23–0.97; P=0.04） without any increased incidence of PTE（OR=1.37; 95% CI, 0.75–2.50; P=0.31） in the studies of a greater proportion（≥40%） of patients with Child-Pugh class C cirrhosis receiving TIPS, and TIPS with covered stent did not increase the risk of PTE compared to ET（OR=1.52, 95% CI =0.82–2.80, P=0.18）. It was concluded that TIPS with covered stent might be considered the preferred choice of therapy in patients with severe liver disease for secondary prophylaxis.展开更多
Although the number of hospitalizations for non-variceal gastrointestinal bleeding has decreased inrecent years,acute upper gastrointestinalhemorrhage continues to be a common reason forhospital admission,and peptic u...Although the number of hospitalizations for non-variceal gastrointestinal bleeding has decreased inrecent years,acute upper gastrointestinalhemorrhage continues to be a common reason forhospital admission,and peptic ulcers account for atleast fifty percent of all cases.Despite the fact thatbleeding from ulcers ceases spontaneously inapproximately 80% of patients,it is still a展开更多
基金supported by the Natural Science Foundation of Central Hospital of Wuhan(No.YQ16B01)
文摘Endoscopic therapy（ET） is most common method for preventing variceal bleeding in cirrhosis, but the outcomes are not perfect. Recently, transjugular intrahepatic portosystemic shunt（TIPS） is introduced into clinical practice. However, the beneficial effects of TIPS compared to ET on cirrhotic patients is unknown. The aim of this study was to evaluate and compare the effects of TIPS with those of the most frequently used ET for prevention of variceal rebleeding（VRB） in liver cirrhosis. The PubMed, EMBASE, and Cochrane Library databases were searched from inception to February 2017. The primary study outcomes included the incidence of VRB, all-cause mortality, bleeding-related death, and the incidence of post-treatment hepatic encephalopathy（PTE）. The odds ratios（ORs） with 95% confidence intervals（CI） were pooled for dichotomous variables. Subgroup analyses were performed. Twenty-four studies were eligible and they included 1120 subjects treated with TIPS and 1065 subjects treated with ET. Although there was no significant difference in survival and PTE, TIPS was superior to ET in decreasing the incidence of VRB（OR=0.27; 95% CI, 0.19–0.39, P〈0.00001）, and decreasing the incidence of bleeding-related death（OR=0.21; 95% CI, 0.13–0.32, P〈0.00001）. Subgroup analysis found a lower mortality（OR=0.48; 95% CI, 0.23–0.97; P=0.04） without any increased incidence of PTE（OR=1.37; 95% CI, 0.75–2.50; P=0.31） in the studies of a greater proportion（≥40%） of patients with Child-Pugh class C cirrhosis receiving TIPS, and TIPS with covered stent did not increase the risk of PTE compared to ET（OR=1.52, 95% CI =0.82–2.80, P=0.18）. It was concluded that TIPS with covered stent might be considered the preferred choice of therapy in patients with severe liver disease for secondary prophylaxis.
文摘Although the number of hospitalizations for non-variceal gastrointestinal bleeding has decreased inrecent years,acute upper gastrointestinalhemorrhage continues to be a common reason forhospital admission,and peptic ulcers account for atleast fifty percent of all cases.Despite the fact thatbleeding from ulcers ceases spontaneously inapproximately 80% of patients,it is still a
