{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:16:06Z","timestamp":1788452166495,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,11,6]],"date-time":"2021-11-06T00:00:00Z","timestamp":1636156800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>A preemptive transjugular intrahepatic portosystemic shunt (p\u2010TIPSS) after acute variceal bleeding (AVB) is advocated. However, when compared with the current standard of care, the survival benefit of p\u2010TIPSS is questionable. We performed a systematic review, meta\u2010analysis, and trial sequential analysis of randomized control trials (RCTs) to assess the survival benefit of p\u2010TIPSS in patients with cirrhosis and AVB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Comprehensive literature search of three bibliographic databases (MEDLINE, Embase, and Cochrane) was conducted from inception till May 2021. All study types evaluating the survival benefit of p\u2010TIPSS in AVB were considered for inclusion. The relative risk (RR) of mortality and rebleeding at 6\u00a0weeks and mortality at 1\u00a0year with a random\u2010effects model was computed. Trial sequential analysis was performed for the primary outcome of 6\u2010week mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of nine studies (four RCTs and five cohort studies) comprising 2861 patients with AVB were included. The overall pooled risks of mortality at 6\u00a0weeks and 1\u00a0year were 17.9% (95% confidence interval [CI]: 16.5\u201319.3%) and 26.7% (95% CI: 25.0\u201328.3%), respectively. Although p\u2010TIPSS was associated with lower 6\u2010week rebleeding risk (RR\u00a0=\u00a00.20; 95% CI\u00a0=\u00a00.13\u20130.29, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%), data from pooled RCTs showed no significant difference in mortality at 6\u00a0weeks (RR\u00a0=\u00a00.33; 95% CI\u00a0=\u00a00.08\u20131.36, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a063%) or at 1\u00a0year (RR\u00a0=\u00a00.76; 95% CI\u00a0=\u00a00.51\u20131.14, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a030%). Using trial sequential analysis, required sample size to detect a 20% relative risk reduction in mortality at 6\u00a0weeks with p\u2010TIPSS was estimated to be 6317, which is beyond the total number of patients available for analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This meta\u2010analysis found that the available data from RCTs are insufficient to confer 6\u2010week mortality benefit with p\u2010TIPSS compared with standard of care; thus, adequately powered RCTs are required.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.15714","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T21:29:17Z","timestamp":1634765357000},"page":"455-463","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Does preemptive transjugular intrahepatic portosystemic shunt improve survival after acute variceal bleeding? Systematic review, meta\u2010analysis, and trial sequential analysis of randomized trials"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8274-4526","authenticated-orcid":false,"given":"Ikram","family":"Hussain","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Woodlands Health Campus  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0727-1183","authenticated-orcid":false,"given":"Yu Jun","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Changi General Hospital  Singapore"},{"name":"Duke\u2010NUS Academic Medical Centre, CGH Campus  Singapore"},{"name":"Duke\u2010NUS Medicine ACP  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0859-5822","authenticated-orcid":false,"given":"Rahul","family":"Lohan","sequence":"additional","affiliation":[{"name":"Department of Diagnostics Radiology Khoo Teck Puat Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7517-9859","authenticated-orcid":false,"given":"Su","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Hepatology Research Institute The First Affiliated Hospital of Fujian Medical University  Fuzhou Fujian China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5092-4821","authenticated-orcid":false,"given":"Rahul","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Changi General Hospital  Singapore"},{"name":"Duke\u2010NUS Academic Medical Centre, CGH Campus  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,11,6]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0901512"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.844"},{"key":"e_1_2_5_4_1","article-title":"Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta\u2010analysis","volume":"4","author":"Roberts D","year":"2021","journal-title":"Cochrane Database Syst. 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