Comparison of Embolic Agents for Varices During Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Variceal Bleeding: Coil-only or Combined? : A Systematic Review and Meta-analysis

Aims There are multiple embolic agents applied during variceal embolization, including coils ,gel , vascular plugs and gelatin sponge. The efficacy and safety of coil versus combination therapy remains controversial. Therefore, we performed this systematic review and meta-analysis to compare the clinical outcomes of coil vs combined therapy (coil and other agents) for variceal embolization during transjugular intrahepatic portosystemic shunt (TIPS).

Methods We performed a literature search through October 2022 for all studies reporting the clinical outcomes of coil or combined emblization therapy (coil with any other embolic agents) for variceal embolization during TIPS. The outcomes of interest were variceal rebleeding, shunt dysfunction, encephalopathy and mortality. The pooled proportions of our data with the corresponding 95% confidence intervals were analyzed using the random-effects model ([Table 1]).

Table 1 Differences in complications between Coil-only and Combined agents.

Results A total of 14 studies were included. For coil only group, the pooled bleeding, shunt dysfunction, encephalopathy and mortality rates were 15% , 14.1%, 25.9% and 26.1% respectively (Table.2). For the combined group, the pooled bleeding, shunt dysfunction, encephalopathy and mortality rates were 13.4% , 26.7% , and 15.6%, respectively. The pooled mortality (P=0.0039) rate was statistically significant. The pooled bleeding, shunt dysfunction , and encephalopathy were similar between the two groups group (Table.2)

Conclusions Our study shows that combination of coil with other embolic agents for variceal bleeding during TIPS reduced mortality. Both our study groups had comparable rates of bleeding, shunt dysfunction and encephalopathy. Additional randomized controlled trials comparing coil only vs. combined emblization therapy during TIPS are warranted to validate our findings.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
14 April 2023