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Surgical shunting versus transjugular intrahepatic portasystemic shunting for bleeding varices resulting from portal hypertension and cirrhosis: a meta-analysis.
Am Surg. 2010 Aug; 76(8):857-64.AS

Abstract

Surgical shunting was the mainstay in treating portal hypertension for years. Recently, transjugular intrahepatic portasystemic shunting (TIPS) has replaced surgical shunting, first as a "bridge" to transplantation and ultimately as first-line therapy for bleeding varices. This study was undertaken to examine evidence from trials comparing TIPS with surgical shunting to reassess the role of surgery in treating portal hypertension. The National Library of Medicine and the National Institutes of Health were searched for clinical trials comparing surgical shunting with TIPS. Meta-analysis using the fixed effects model was undertaken with end points of 30-day and 1- and 2-year survival and shunt failure (inability to complete shunt, irreversible shunt occlusion, major rehemorrhage, unanticipated liver transplantation, death). Three prospective randomized trials and one retrospective case-controlled study were identified. Analysis was limited to patients of Child Classes A or B. Significantly better 2-year survival (OR 2.5 [1.2-5.2]) and significantly less frequent shunt failure (OR 0.3 [0.1-0.9]) were seen in patients undergoing surgical shunting compared with TIPS. Meta-analysis promotes surgical shunting relative to TIPS because of improved survival and less frequent shunt failure. Surgical shunting should be accepted as first-line therapy for bleeding varices resulting from portal hypertension.

Authors+Show Affiliations

Digestive Disorders Center, Tampa General Hospital and the Department of Surgery, University of South Florida, Tampa, Florida 33601, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

20726417

Citation

Clark, Whalen, et al. "Surgical Shunting Versus Transjugular Intrahepatic Portasystemic Shunting for Bleeding Varices Resulting From Portal Hypertension and Cirrhosis: a Meta-analysis." The American Surgeon, vol. 76, no. 8, 2010, pp. 857-64.
Clark W, Hernandez J, McKeon B, et al. Surgical shunting versus transjugular intrahepatic portasystemic shunting for bleeding varices resulting from portal hypertension and cirrhosis: a meta-analysis. Am Surg. 2010;76(8):857-64.
Clark, W., Hernandez, J., McKeon, B., Villadolid, D., Al-Saadi, S., Mullinax, J., Ross, S. B., & Rosemurgy, A. S. (2010). Surgical shunting versus transjugular intrahepatic portasystemic shunting for bleeding varices resulting from portal hypertension and cirrhosis: a meta-analysis. The American Surgeon, 76(8), 857-64.
Clark W, et al. Surgical Shunting Versus Transjugular Intrahepatic Portasystemic Shunting for Bleeding Varices Resulting From Portal Hypertension and Cirrhosis: a Meta-analysis. Am Surg. 2010;76(8):857-64. PubMed PMID: 20726417.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical shunting versus transjugular intrahepatic portasystemic shunting for bleeding varices resulting from portal hypertension and cirrhosis: a meta-analysis. AU - Clark,Whalen, AU - Hernandez,Jonathan, AU - McKeon,Brianne, AU - Villadolid,Desiree, AU - Al-Saadi,Sam, AU - Mullinax,John, AU - Ross,Sharona B, AU - Rosemurgy,Alexander S,2nd PY - 2010/8/24/entrez PY - 2010/8/24/pubmed PY - 2010/9/3/medline SP - 857 EP - 64 JF - The American surgeon JO - Am Surg VL - 76 IS - 8 N2 - Surgical shunting was the mainstay in treating portal hypertension for years. Recently, transjugular intrahepatic portasystemic shunting (TIPS) has replaced surgical shunting, first as a "bridge" to transplantation and ultimately as first-line therapy for bleeding varices. This study was undertaken to examine evidence from trials comparing TIPS with surgical shunting to reassess the role of surgery in treating portal hypertension. The National Library of Medicine and the National Institutes of Health were searched for clinical trials comparing surgical shunting with TIPS. Meta-analysis using the fixed effects model was undertaken with end points of 30-day and 1- and 2-year survival and shunt failure (inability to complete shunt, irreversible shunt occlusion, major rehemorrhage, unanticipated liver transplantation, death). Three prospective randomized trials and one retrospective case-controlled study were identified. Analysis was limited to patients of Child Classes A or B. Significantly better 2-year survival (OR 2.5 [1.2-5.2]) and significantly less frequent shunt failure (OR 0.3 [0.1-0.9]) were seen in patients undergoing surgical shunting compared with TIPS. Meta-analysis promotes surgical shunting relative to TIPS because of improved survival and less frequent shunt failure. Surgical shunting should be accepted as first-line therapy for bleeding varices resulting from portal hypertension. SN - 0003-1348 UR - https://www.unboundmedicine.com/medline/citation/20726417/Surgical_shunting_versus_transjugular_intrahepatic_portasystemic_shunting_for_bleeding_varices_resulting_from_portal_hypertension_and_cirrhosis:_a_meta_analysis_ L2 - http://www.diseaseinfosearch.org/result/5881 DB - PRIME DP - Unbound Medicine ER -