Published online Dec 7, 2026. doi: 10.3748/wjg.121243
Revised: May 19, 2026
Accepted: June 29, 2026
Published online: December 7, 2026
Processing time: 202 Days and 14.7 Hours
In clinical practice, the choices of stent diameter and dilation strategy during the transjugular intrahepatic portosystemic shunt (TIPS) procedure are critical factors that influence patient outcomes, necessitating a balance between adequate portal decompression and preventing complications. Therefore, optimizing stent im
To evaluate the impact of underdilating an 8-mm expanded polytetrafluoroethylene (ePTFE)-covered stent to ≤ 6 mm vs ≥ 7 mm during the TIPS procedure on postoperative overt hepatic encephalopathy (OHE), rebleeding, stent dys
This retrospective cohort study included 192 patients who underwent TIPS with an 8-mm ePTFE-covered stent in a tertiary hospital between August 1, 2016, and December 31, 2020. Patients were divided into two groups based on underdilation diameter (≤ 6 mm vs ≥ 7 mm); subsequent 1:1 propensity score matching (PSM) yielded 78 patients per group. The primary endpoints were overall survival (OS) and OHE incidence, and the secondary endpoints included variceal rebleeding and shunt dysfunction. Kaplan-Meier survival analysis, the log-rank test, and multivariable Cox regression analysis were used to assess the effect of stent underdilation on post-TIPS survival.
Among the 192 patients, 49 developed OHE within 1 year after TIPS. During follow-up, 48 patients died, 24 experienced rebleeding, and 15 developed shunt dysfunction. Before PSM, the incidences of OHE in the ≤ 6 mm and ≥ 7 mm groups were 24.4% and 26.5%, respectively (P = 0.748); after PSM, these incidences were 21.8% and 28.2% (P = 0.355). Mortality rates were lower in the ≤ 6 mm group than in the ≥ 7 mm group both before (16.7% vs 32.4%, P = 0.012) and after matching (14.1% vs 34.6%, P = 0.003). No significant differences were observed between the groups regarding rebleeding rates (before PSM: 14.4% vs 10.8%, P = 0.444; after PSM: 14.1% vs 11.5%, P = 0.632) or shunt dysfunction rates (before PSM: 5.6% vs 9.8%, P = 0.274; after PSM: 5.1% vs 11.5%, P = 0.148). Ordinal logistic regression demonstrated no significant association between the underdilation strategy and OHE severity (odds ratio = 0.683, 95% confidence interval: 0.194-2.404, P = 0.552). Kaplan-Meier analysis after PSM showed improved OS in the ≤ 6 mm group (log-rank P = 0.015). Multivariable Cox regression identified underdilation to ≤ 6 mm as an independent protective factor for OS (hazard ratio = 0.422, 95% confidence interval: 0.203-0.877, P = 0.021).
Underdilating an 8-mm ePTFE-covered stent during the TIPS procedure does not affect postoperative rebleeding or shunt dysfunction. Compared with underdilation to ≥ 7 mm, underdilation to ≤ 6 mm does not decrease the incidence of postoperative OHE but reduces mortality risk, conferring a substantial survival benefit.
Core Tip: In our study, underdilating an 8-mm expanded polytetrafluoroethylene-covered stent to ≤ 6 mm vs ≥ 7 mm during transjugular intrahepatic portosystemic shunt showed no significant differences regarding the incidences of postoperative rebleeding, shunt dysfunction, and overt hepatic encephalopathy; however, it substantially reduced the mortality risk in the ≤ 6 mm group. Underdilating the stent to ≤ 6 mm appears to recalibrate the risk-benefit balance during transjugular intrahepatic portosystemic shunt with 8-mm expanded polytetrafluoroethylene-covered stents, yielding superior mid-to-long-term survival benefits.