Cochrane · systematic review · CD000553
Portosystemic shunts versus endoscopic intervention with or without medical treatment for prevention of rebleeding in people with cirrhosis
Simonetti, RG, Perricone, G, Robbins, HL, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Hepato-BiliaryAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
19
No studies
4
Included studies
NR
No studies 4 · 16.7%Ungraded 1 · 4.2%Very low 19 · 79.2%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Portosystemic shunts compared with endoscopic intervention with or without medical treatment for prevention of rebleeding in people with cirrhosis
Population: participants with cirrhosis and with previous oesophagogastric variceal bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Portosystemic shunts vs endoscopic intervention with or without medical treatment | RR 0.99 [0.86, 1.13] | 27 studies · 1828 participants | Very low Downgraded: risk of bias, publication bias |
Rebleeding Portosystemic shunts vs endoscopic intervention with or without medical treatment | RR 0.4 [0.33, 0.5] | 26 studies · 1769 participants | Very low Downgraded: risk of bias, publication bias |
Health‐related quality of life Portosystemic shunts vs endoscopic intervention with or without medical treatment | no estimate extracted | NR | No studies |
Mortality due to rebleeding Portosystemic shunts vs endoscopic intervention with or without medical treatment | RR 0.51 [0.34, 0.76] | 26 studies · 1779 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Acute hepatic encephalopathy Portosystemic shunts vs endoscopic intervention with or without medical treatment | RR 1.6 [1.33, 1.92] | 24 studies · 1649 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Chronic hepatic encephalopathy Portosystemic shunts vs endoscopic intervention with or without medical treatment | RR 2.51 [1.38, 4.55] | 13 studies · 956 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Total shunt compared with endoscopic intervention for prevention of rebleeding in people with cirrhosis
Population: participants with cirrhosis and with previous oesophagogastric variceal bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Total shunt vs endoscopic intervention | RR 0.46 [0.19, 1.13] | 3 studies · 164 participants | Very low Downgraded: risk of bias, imprecision |
Rebleeding Total shunt vs endoscopic intervention | RR 0.28 [0.14, 0.56] | 2 studies · 127 participants | Very low Downgraded: risk of bias, imprecision |
Health‐related quality of life Total shunt vs endoscopic intervention | no estimate extracted | NR | No studies |
Mortality due to rebleeding Total shunt vs endoscopic intervention | RR 0.25 [0.06, 0.96] | 3 studies · 164 participants | Very low Downgraded: risk of bias, imprecision |
Acute hepatic encephalopathy Total shunt vs endoscopic intervention | RR 1.66 [0.7, 3.92] | 2 studies · 115 participants | Very low Downgraded: risk of bias, imprecision |
Chronic hepatic encephalopathy Total shunt vs endoscopic intervention | no estimate extracted | 1 study · 69 participants | Ungraded |
Distal splenorenal shunt compared with endoscopic intervention for prevention of rebleeding in people with cirrhosis
Population: participants with cirrhosis and with previous oesophagogastric variceal bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Distal splenorenal shunt vs endoscopic intervention | RR 0.93 [0.65, 1.33] | 5 studies · 352 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Rebleeding Distal splenorenal shunt vs endoscopic intervention | RR 0.26 [0.11, 0.65] | 5 studies · 330 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Health‐related quality of life Distal splenorenal shunt vs endoscopic intervention | no estimate extracted | NR | No studies |
Mortality due to rebleeding Distal splenorenal shunt vs endoscopic intervention | RR 0.31 [0.13, 0.74] | 5 studies · 352 participants | Very low Downgraded: risk of bias, imprecision |
Acute hepatic encephalopathy Distal splenorenal shunt vs endoscopic intervention | RR 1.7 [0.94, 3.08] | 4 studies · 287 participants | Very low Downgraded: risk of bias, imprecision |
Chronic hepatic encephalopathy Distal splenorenal shunt vs endoscopic intervention | RR 2.51 [1.38, 4.55] | 2 studies · 170 participants | Very low Downgraded: risk of bias, imprecision |
Transjugular intrahepatic portosystemic shunt compared with endoscopic intervention with or without medical treatment for prevention of rebleeding in people with cirrhosis
Population: participants with cirrhosis with previous oesophagogastric variceal bleeding
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Transjugular intrahepatic portosystemic shunt vs endoscopic intervention with or without medical treatment | RR 1.1 [0.92, 1.31] | 19 studies · 1312 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Rebleeding Transjugular intrahepatic portosystemic shunt vs endoscopic intervention with or without medical treatment | RR 0.44 [0.36, 0.55] | 19 studies · 1312 participants | Very low Downgraded: risk of bias, publication bias |
Health‐related quality of life Transjugular intrahepatic portosystemic shunt vs endoscopic intervention with or without medical treatment | no estimate extracted | NR | No studies |
Mortality due to rebleeding Transjugular intrahepatic portosystemic shunt vs endoscopic intervention with or without medical treatment | RR 0.65 [0.4, 1.04] | 18 studies · 1263 participants | Very low Downgraded: risk of bias, publication bias |
Acute hepatic encephalopathy Transjugular intrahepatic portosystemic shunt vs endoscopic intervention with or without medical treatment | RR 1.61 [1.29, 1.99] | 18 studies · 1247 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Chronic hepatic encephalopathy Transjugular intrahepatic portosystemic shunt vs endoscopic intervention with or without medical treatment | RR 1.88 [0.93, 3.8] | 10 studies · 717 participants | Very low Downgraded: risk of bias, imprecision, publication bias |