Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 8, 2015; 7(13): 1797-1806
Published online Jul 8, 2015. doi: 10.4254/wjh.v7.i13.1797
Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis
Ivo C Ditah, Badr F Al Bawardy, Behnam Saberi, Chobufo Ditah, Patrick S Kamath
Ivo C Ditah, Badr F Al Bawardy, Behnam Saberi, Patrick S Kamath, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Chobufo Ditah, Department of Medicine, University of Yaoundé I Faculty of Medicine, BP 1365 Yaoundé, Cameroon
Author contributions: Ditah IC, Al Bawardy BF and Kamath PS Involved in study conception and design, abstraction of data, analysis and interpretation of data; drafting of the manuscript, critical revision of the manuscript for important intellectual content, and study supervision; Saberi B and Ditah C involved in acquisition of data; and revision of manuscript.
Conflict-of-interest statement: The authors do not have any conflicts of interest.
Data sharing statement: Open-Access: This article is an open-access article which was Invited by the journal editors and fully peer-reviewed by external reviewers. Researchers can distribute, remix, adapt, build upon this work, provided the original work is properly cited and the use is non-commercial.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ivo C Ditah, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States. ivoditah@yahoo.com
Telephone: +1-952-6882201
Received: March 17, 2015
Peer-review started: March 17, 2015
First decision: April 10, 2015
Revised: May 3, 2015
Accepted: June 9, 2015
Article in press: June 11, 2015
Published online: July 8, 2015
Processing time: 115 Days and 15.8 Hours
Abstract

AIM: To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in refractory hepatic hydrothorax (RHH) in a systematic review and cumulative meta-analysis.

METHODS: A comprehensive literature search was conducted on MEDLINE, EMBASE, and PubMed covering the period from January 1970 to August 2014. Two authors independently selected and abstracted data from eligible studies. Data were summarized using a random-effects model. Heterogeneity was assessed using the I2 test.

RESULTS: Six studies involving a total of 198 patients were included in the analysis. The mean (SD) age of patients was 56 (1.8) years. Most patients (56.9%) had Child-Turcott-Pugh class C disease. The mean duration of follow-up was 10 mo (range, 5.7-16 mo). Response to TIPSS was complete in 55.8% (95%CI: 44.7%-66.9%), partial in 17.6% (95%CI: 10.9%-24.2%), and absent in 21.2% (95%CI: 14.2%-28.3%). The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mmHg. The incidence of TIPSS-related encephalopathy was 11.7% (95%CI: 6.3%-17.2%), and the 45-d mortality was 17.7% (95%CI: 11.34%-24.13%).

CONCLUSION: TIPSS is associated with a clinically relevant response in RHH. TIPSS should be considered early in these patients, given its poor prognosis.

Keywords: Cirrhosis; Portal hypertension; Hepatic hydrothorax; Transjugular intrahepatic portosystemic stent shunt; Meta-analysis

Core tip: Evidence on the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in patients with refractory hepatic hydrothorax (RHH) is scarce and variable. This paper summarizes available data on the effectiveness of TIPSS in RHH in a cumulative meta-analysis. The sum total of the evidence shows that TIPSS is associated with a clinically relevant response in three-quarters of patients with medically RHH. We suggest that TIPSS be considered early in patients with RHH, given its impact on quality of life and prognosis. However, caution should be exercised in older patients and those with severe underlying liver or renal dysfunction.