- Design
- Meta-analysis of randomised trials and cohort studies
- Population
- 14 studies, 3,079 patients with decompensated cirrhosis and variceal bleeding
- Primary outcome
- Rebleeding after TIPS
- Effect
- Overall RR 0.67 (0.57 to 0.79); gastric varices RR 0.50 (0.34 to 0.74); survival RR 1.00
A meta-analysis pooled 14 randomised and cohort studies, 3,079 patients with decompensated cirrhosis and oesophageal or gastric variceal bleeding, comparing TIPS alone with TIPS plus variceal embolisation.
Rebleeding was lower with combined treatment (RR 0.67, 95% CI 0.57 to 0.79). The benefit was concentrated in gastric variceal bleeding (RR 0.50, 0.34 to 0.74); for isolated oesophageal varices there was no clear difference (RR 0.83, 0.51 to 1.35). Hepatic encephalopathy was also less frequent with embolisation (RR 0.82), but survival was the same (RR 1.00).
The pool mixed randomised trials with cohort studies, so selection may favour the combined approach. Still, the gastric variceal signal is consistent and supports discussing embolisation at the time of TIPS for these patients.
- For gastric variceal bleeding, consider embolisation alongside TIPS to reduce rebleeding
- For isolated oesophageal varices, embolisation added no clear benefit
- Do not expect a survival gain from adding embolisation
- Monitor for hepatic encephalopathy after TIPS with or without embolisation
Why it matters
It helps decide when an extra procedure at TIPS is worth doing.
Don't overread it
Survival did not differ, and the pool includes non-randomised cohort studies.
The statistics, in plain English
An RR of 0.50 means half the rebleeding risk in gastric varices. Because some included studies were not randomised, part of this difference may reflect which patients were chosen for embolisation.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free