Supplemental Material for: Transjugular intrahepatic portosystemic shunt versus endoscopic treatment for variceal rebleeding: a systematic review and meta-analysis

A systematic search of PubMed, Embase, Web of Science, Scopus and the Cochrane Library was performed to identify randomized controlled trials (RCTs) comparing TIPS versus ET for meta-analysis.</p><p dir="ltr">Results: This study has been registered in PROSPERO (CRD42024592387). Data were extracted from 23 RCTs, including 1860 patients. Compared to the ET group, patients in the TIPS group exhibited a lower rate of variceal rebleeding (RR, 0.39; 95% CI, 0.33 to 0.47).

The incidence of ascites (RR, 0.40; 95% CI, 0.28 to 0.58), spontaneous bacterial peritonitis (RR, 0.42; 95% CI, 0.19 to 0.91) and hepatorenal syndrome (RR, 0.35; 95% CI, 0.17 to 0.71) were lower in the TIPS group. The use of covered stent (RR, 0.63; 95% CI, 0.45 to 0.89) and early TIPS (RR, 0.67; 95% CI, 0.46 to 0.98) were associated with reduced mortality. For hepatic encephalopathy (HE), early TIPS did not significantly increase the risk (RR, 1.27; 95% CI, 0.84 to 1.90).</p><p dir="ltr">Conclusion: In conclusion, TIPS significantly reduced variceal rebleeding and complications including ascites, spontaneous bacterial peritonitis and hepatorenal syndrome.

The use of bare stent and non-early TIPS was correlated with poorer survival. Moreover, early TIPS significantly reduced mortality without elevating HE.</p>