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Published on: June 18, 2020
Transjugular intrahepatic portosystemic shunt for pediatric portal hypertension: A meta-analysis
Driss Raissi1, Sneh Brahmbhatt1, Qian Yu1
1Department of Radiology, Medicine and Obstetrics and Gynecology, University of Kentucky, College of Medicine, Lexington, United States.
Insights
Transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective treatment for children experiencing portal hypertensive complications. This procedure offers significant improvements for conditions like variceal bleeding and ascites.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Hepatology
Background:
- Portal hypertensive complications in children can lead to severe morbidity.
- Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment in adults, but its use in pediatric populations requires evaluation.
Purpose of the Study:
- To assess the feasibility and effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) in pediatric patients (<18 years old) with portal hypertensive complications.
Main Methods:
- A systematic review and meta-analysis of observational studies was conducted.
- PubMed and Cochrane Library databases were searched for relevant clinical studies.
- Data on baseline characteristics, laboratory values, and clinical outcomes were extracted and analyzed.
Main Results:
- The pooled technical and hemodynamic success rates for TIPS were 94% and 91%, respectively.
- TIPS demonstrated high efficacy in resolving variceal bleeding (99.5%) and improving refractory ascites (96%).
- Survival or successful liver transplantation was observed in 88% of patients, with a notable shunt dysfunction rate of 27%.
Conclusions:
- Transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective intervention for pediatric patients with portal hypertensive complications.
- The procedure shows significant promise in managing severe gastrointestinal bleeding and ascites in children.
- Further comparative studies are recommended to solidify the role of TIPS in pediatric hepatology.
Abstract:
To evaluate the feasibility of transjugular intrahepatic portosystemic shunt (TIPS) in children with portal hypertensive complications, PubMed and Cochrane Library were queried to identify clinical studies evaluating TIPS in patients <18 years old. Baseline clinical characteristics, laboratory values, and clinical outcomes were extracted. Eleven observational studies totaling 198 subjects were included in the study. The pooled technical success rate and hemodynamic success rate were 94% (95% confidence interval [CI]: 86-99%) and 91% (95% CI: 82-97%), respectively; ongoing variceal bleeding resolved in 99.5% (95% CI: 97-100%); refractory ascites was improved in 96% (95% CI: 69-100%); post-TIPS bleeding rate was 14% (95% CI: 1-33%); 88% of patients were alive or successfully received liver transplant (95% CI: 79-96%); and shunt dysfunction rate was 27% (95% CI: 17-38%). Hepatic encephalopathy occurred in 10.6% (21/198), though 85.7% (18/21) resolved with medical management only. In conclusion, based on moderate levels of evidence, TIPS is a safe and effective intervention that should be considered in pediatric patients with portal hypertensive complications. Future comparative studies are warranted.
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