{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:51:52Z","timestamp":1792007512389,"version":"4.4.0"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2020,10,17]],"date-time":"2020-10-17T00:00:00Z","timestamp":1602892800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007299","name":"Harvard Catalyst","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007299","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gastroenterology Research and Practice"],"published-print":{"date-parts":[[2020,10,17]]},"abstract":"<jats:p>Introduction. Hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement remains a leading adverse event. Controversy remains regarding the optimal stent diameter given that smaller stents may decrease the amount of shunted blood and decrease the risk of HE, but stent patency and\/or clinical adequacy of portal decompression may also be affected. We aim to provide meta-analysis-based evidence regarding the safety and efficacy of 8\u2009mm vs. 10\u2009mm stents during TIPS placement. Methods. PubMed, Embase, Cochrane Library, and Web of Science were searched for studies comparing 8\u2009mm and 10\u2009mm stents during TIPS placement for portal hypertension decompression in cirrhotic patients. Randomized controlled trials and cohort studies were prioritized for inclusion. Overall evaluation of quality and bias for each study was performed. The outcomes assessed were the prevalence of HE, rebleeding or failure to control refractory ascites, and overall survival. Subgroup analysis based on TIPS indication was conducted. Results. Five studies with a total number of 489 cirrhotic patients were identified. The pooled hazard ratio (HR) of post-TIPS HE was significantly lower in patients in the 8\u2009mm stent group than in the 10\u2009mm stent group (HR: 0.68, 95% CI: 0.51~0.92, <jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                     <\/a:math>\n                  <\/jats:inline-formula> value &lt; 0.0001). The combined HR of post-TIPS rebleeding\/the need for paracentesis was significantly higher in patients in the 8\u2009mm stent group than in the 10\u2009mm stent group (HR: 1.76, 95% CI: 1.22~2.55, <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                     <\/c:math>\n                  <\/jats:inline-formula> value &lt; 0.0001). There was no statistically significant difference in the overall survival between the 8\u2009mm and 10\u2009mm stent groups. The combined risk of HE in the variceal bleeding subgroup was statistically lower (HR: 0.52, CI: 0.34-0.80) with an 8\u2009mm stent compared with a 10\u2009mm stent. The combined risk of both rebleeding\/paracentesis and survival was not statistically significant between 8\u2009mm and 10\u2009mm stent use in subgroup analysis. Conclusion. 8\u2009mm stents during TIPS placement are associated with a significant lower risk of HE compared to 10\u2009mm stents (32% decreased risk), as well as a 76% increased risk of rebleeding\/paracentesis. Meta-analysis results suggest that there is not one superior stent choice for all clinical scenarios and that the TIPS indication of variceal bleeding or refractory ascites might have different appropriate selection of the shunt diameter.<\/jats:p>","DOI":"10.1155\/2020\/9149065","type":"journal-article","created":{"date-parts":[[2020,10,18]],"date-time":"2020-10-18T03:05:07Z","timestamp":1602990307000},"page":"1-10","source":"Crossref","is-referenced-by-count":16,"title":["Transjugular Intrahepatic Portosystemic Shunt Placement for Portal Hypertension: Meta-Analysis of Safety and Efficacy of 8\u2009mm vs. 10\u2009mm Stents"],"prefix":"10.1155","volume":"2020","author":[{"given":"Jiangtao","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Radiology, IR Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"},{"name":"Department of Gastroenterology, Chinese PLA General Hospital Hainan Hospital, Sanya, Hainan 572016, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Paul","family":"Wehrenberg-Klee","sequence":"additional","affiliation":[{"name":"Department of Radiology, IR Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily D.","family":"Bethea","sequence":"additional","affiliation":[{"name":"Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul N.","family":"Uppot","sequence":"additional","affiliation":[{"name":"Department of Radiology, IR Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Radiology, IR Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3426-4907","authenticated-orcid":true,"given":"Suvranu","family":"Ganguli","sequence":"additional","affiliation":[{"name":"Department of Radiology, IR Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"},{"name":"Department of Radiology, Division of Interventional Radiology, Boston Medical Center, Boston University School of Medicine, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"issue":"1","key":"1","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/hep.28906","article-title":"Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases","volume":"65","author":"G. 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