Pre-Emptive TIPS Versus Standard Care for Patients With Cirrhosis and Variceal Bleeding: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Exp Hepatol 2026;16(3):103491
Date
03/02/2026Pubmed ID
41767699Pubmed Central ID
PMC12936677DOI
10.1016/j.jceh.2026.103491Scopus ID
2-s2.0-105030880472 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Acute variceal bleeding remains a severe and potentially fatal complication in patients with cirrhosis and portal hypertension. Recent randomized controlled trials (RCTs) have demonstrated improved bleeding control and potential survival benefits when a transjugular intrahepatic portosystemic shunt (TIPS) is placed early, within 24-72 h of admission (p-TIPS). Hence, this meta-analysis aims to evaluate the potential of p-TIPS in achieving a better survival rate, preventing rebleeding, and reducing adverse events compared to the standard of care in the treatment of variceal bleeding in patients with cirrhosis.
METHODS: An extensive literature search was performed in PubMed (MEDLINE), Scopus, WOS, ClinicalTrials.gov, and CENTRAL up to 16 June 2025. A pooled analysis was conducted to combine multiple studies, using either risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, along with 95% confidence intervals. All statistical analyses were conducted using R version 4.3. PROSPERO ID: CRD420251106950.
RESULTS: Six RCTs and 424 patients were included. P-TIPS non-significantly increased the rate of overall survival at <6 weeks (RR: 1.11, 95% CI: [0.95; 1.31], P = 0.1942), at <1 year (RR: 1.22, 95% CI: [0.98; 1.51], P = 0.0688), and at long-term follow-up (RR:0.77, 95% CI: 0.23; 2.30, P = 0.5931). P-TIPS significantly decreased rebleeding rate at <6 weeks (RR: 0.15, 95% CI: [0.07; 0.34], P < 0.0001), and at final follow-up (RR: 0.38, 95% CI: [0.23; 0.63], P = 0.0002). Also, p-TIPS demonstrated a significant reduction in new/worsening ascites (RR: 0.50, 95% CI [0.34, 0.75], P = 0.0008), spontaneous bacterial peritonitis (RR: 0.19, 95% CI [0.05, 0.64], P = 0.0074), hepatorenal syndrome (RR: 0.37, 95% CI [0.15, 0.92], P = 0.03), and the composite outcome of rebleeding or death (RR: 0.27, 95% CI [0.14, 0.53], P = 0.0002) compared to standard care. Still, there was no significant difference between the two groups in terms of transplant-free survival, incidence of hepatic encephalopathy, number of RBC units transfused during follow-up, or length of hospital stay.
CONCLUSION: In patients with cirrhosis and variceal bleeding, p-TIPS significantly decreased rebleeding rate across all time points, the incidence of new/worsening ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and a composite outcome of rebleeding or death compared with standard care.
