Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: A systematic review and meta-analysis

• A meta-analysis was performed to compare the clinical efficacy of TIPS using 8 mm covered stents to that using 10 mm diameter covered stents in patients with liver cirrhosis. • The 8 mm covered stent group had greater one-year (odds ratio [OR], 2.88; P = 0.003) and three-year overall survival (OR, 1.81; P = 0.04) and lower hepatic encephalopathy rate (OR, 0.69; P = 0.04) compared to 10 mm covered stent group. • No significant differences in variceal rebleeding (OR, 0.80; P = 0.67) was found between the two stents but shunt dysfunction rate was lower in 10 mm covered stent group (OR, 2.26; P = 0.003). The purpose of this study was to make a systematic review and meta-analysis to determine the stent diameter (8 mm vs. 10 mm) that conveys better safety and clinical efficacy for transjugular intrahepatic portosystemic shunt (TIPS). Four databases were used to identify clinical trials published from inception until March 2020. Data were extracted to estimate and compare one-year and three-year overall survivals, hepatic encephalopathy, variceal rebleeding, and shunt dysfunction rates between patients with 8 mm covered stents and those with 10 mm covered stents. Five eligible studies were selected, which included 489 patients (316 men, 173 women). The 8 mm covered stent group had higher efficacy regarding one-year or three-year overall survival (odds ratio [OR], 2.88; P = 0.003) and (OR, 1.81; P = 0.04) and lower hepatic encephalopathy (OR, 0.69; P = 0.04) compared with 10 mm covered stent group. There were no significant differences in variceal rebleeding rate (OR 0.80; P = 0.67). However, shunt dysfunction was lower in 10 mm covered stent group (OR, 2.26; P = 0.003). Our results suggest that the use of 8 mm covered stents should be preferred to that of 10 mm covered stents for TIPS placement when portal pressure is frequently monitored.