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      저자 : ( Felix Zano ) (검색결과 1 건)
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      • Transjugular Intrahepatic Portosystemic Shunting (TIPS) versus Endoscopic Band Ligation and Beta-Blocker Combination Therapy for Secondary Prophylaxis of Variceal Bleeding: A Meta-Analysis

        ( Mariel Dianne Velasco ),( Geraldine Claire Floro ),( Adrian Manuel Fausto ),( Jenis Emmanuel Camenforte ),( Felix Zano ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

        Aims: Variceal hemorrhage is a life-threatening complication of cirrhosis. Combination of endoscopic band ligation (EBL) and nonselective beta-blockers (NSBB) is the current preferred secondary prophylaxis. This meta-analysis aims to determine if transjugular intrahepatic portosystemic shunting (TIPS) is comparable to EBL + NSBB in the prevention of a recurrent variceal bleed. Methods: Included studies were randomized trials where treatment groups underwent TIPS after a variceal bleed. The outcomes measured were recurrence of variceal bleeding, hepatic encephalopathy and mortality. A search of PubMed, ScienceDirect and Cochrane Library for articles up to February 2017 was done using the terms “variceal bleeding”, “varix”, “transjugular intrahepatic portosystemic shunt”, and “TIPS”. Analysis of study data was carried out through RevMan 5.3. Pooled efficacy of the intervention was done by estimating the risk ratio and 95% confidence interval and heterogeneity assessed by evaluating chi-square and I2 tests. Sensitivity analysis was performed to determine cause of heterogeneity. Results: Four studies were included. The risk ratio for recurrence of variceal bleeding was 0.33 (95% CI 0.12 - 0.91), showing benefit for the use of TIPS. The p-value for the chi-square test was 0.06, showing no statistically significant heterogeneity. For the outcome of hepatic encephalopathy, RR was 1.17 (95% CI 0.71 - 1.94). There was a trend towards benefit with the use of TIPS in the prevention of mortality (RR 0.78, 95% CI 0.46 - 1.32). Conclusions: TIPS is a feasible alternative to EBL + NSBB for the secondary prevention of variceal bleeding.

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