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The role of transjugular intrahepatic portosystemic shunt in the management of portal vein thrombosis: a systematic review and meta-analysis

Valentin, Nelson; Korrapati, Praneet; Constantino, Joseph; Young, Ari; Weisberg, Ilan

European Journal of Gastroenterology & Hepatology: October 2018 - Volume 30 - Issue 10 - p 1187–1193
doi: 10.1097/MEG.0000000000001219
Original Articles: Hepatology

Background The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal vein thrombosis (PVT) remains controversial. This study aimed to conduct a systematic review and meta-analysis to evaluate the role of TIPS for the management of PVT in adult patients with liver disease.

Patients and methods Multiple databases were searched through April 2017. Data were gathered to estimate the rates of technical success, portal vein recanalization, portal patency, hepatic encephalopathy, and mean change in portal pressure gradient in patients with PVT who underwent TIPS. Estimates were pooled across studies using the random effects model.

Results Eighteen studies were included in the analysis. The pooled technical success rate was 86.7% [95% confidence interval (CI)=78.6–92.1%]. Rate of portal vein recanalization was 84.4% (95% CI=78.4–89.0%). The rate of complete recanalization was 73.7% (95% CI=64.3–81.3%). Portal patency was 86.9% (95% CI=79.7–91.8%). Mean change in portal pressure gradient was 14.5 mmHg (95% CI=11.3–17.7 mmHg). Hepatic encephalopathy was 25.3% (95% CI=19.2–32.6%). The number of major adverse events reported across studies was low. The majority of the analyses were not associated with substantial heterogeneity.

Conclusion The use of TIPS in the management of PVT is feasible and effective in achieving a significant and sustainable reduction in clot burden with a low risk of major complications. TIPS should be considered as a viable treatment option in patients with PVT. Given the limited amount of randomized comparative studies reported, additional trials are warranted to assess the safety and efficacy of TIPS as a treatment modality in PVT, in comparison to other treatment options, such as anticoagulation.

Division of Digestive Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, New York City, New York, USA

Correspondence to Ilan Weisberg, MD, MSc, Mount Sinai Beth Israel, 10 Union Square East, Suite 2G, New York, NY 10003, USA Tel: +1 212 844 8106; fax: +1 212 844 6336; e-mail: ilan.weisberg@mountsinai.org

Received May 14, 2018

Accepted June 28, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.