Safety and efficacy of transjugular intrahepatic portosystemic shunts vs endoscopic band ligation plus propranolol in patients with cirrhosis with portal vein thrombosis: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis aimed to assess the efficacy and safety of transjugular intrahepatic portosystemic shunts (TIPS) against the combined treatment of endoscopic band ligation (EBL) and propranolol in managing patients with cirrhosis diagnosed with portal vein thrombosis (PVT). METHODS: A literature search from inception to September 2023 was performed using MEDLINE, the Cochrane Library, Web of Science, and Scopus. Independent screening, data extraction, and quality assessment were performed. The main measured outcomes were the incidence and recurrence of variceal bleeding (VB), hepatic encephalopathy, and overall survival. RESULTS: A total of 5 studies were included. For variceal eradication, there was initially no significant difference between the groups; however, after sensitivity analysis, a significant effect emerged (risk ratio [RR], 1.55; P < .0001). TIPS was associated with a significant decrease in the incidence of VB (RR, 0.34; P < .0001) and a higher probability of remaining free of VB in the first 2 years after the procedure (first year: RR, 1.41; P < .0001; second year: RR, 1.58; P < .0001). TIPS significantly reduced the incidence of death due to acute GI bleeding compared with EBL + propranolol (RR, 0.37; P = .05). CONCLUSION: TIPS offers a comprehensive therapeutic advantage over the combined EBL and propranolol regimen, especially for patients with cirrhosis with PVT. Its efficacy in variceal eradication, reducing rebleeding, and mitigating death risks due to acute GI bleeding is evident.

Insulin/high-density lipoprotein cholesterol ratio: A newly-discovered predictor of esophageal varices in patients with hepatitis C virus-related cirrhosis in the absence of diabetes mellitus.

BACKGROUND/AIMS: Insulin resistance (IR) is closely linked with chronic hepatitis C virus (HCV) and its complications, particularly hepatic fibrosis. The aim of the present study was to investigate some biochemical markers that are potentially related to IR as predictors of esophageal varices (EV) in patients with compensated HCV cirrhosis who do not have diabetes or metabolic syndrome. MATERIALS AND METHODS: One hundred subjects without diabetes with compensated HCV-related cirrhosis who did not fulfill the diagnostic criteria of metabolic syndrome were subjected to clinical, laboratory, ultrasonographic, and endoscopic assessments. RESULTS: EV were evident in 73 patients with lower platelet counts and high-density lipoprotein cholesterol (HDL-C) levels. On the contrary, the fasting values of both insulin and glucose, the homeostatic model assessment for insulin resistance (HOMA-IR) score, and the bipolar diameter of the spleen of patients with EV were higher than those of other patients who were varices-free. Multivariate analysis confirmed insulin/HDL-C ratio (P=0.01) and HOMA-IR score (P=0.039) as predictors for the presence of varices. The best cut-off values above which the risk of the latter occurrence increased were 0.147 (sensitivity 89%) and 2.24 (sensitivity 72.6%) for both predictors, respectively. CONCLUSION: The present study recorded two valid predictors of HCV-related EV: HOMA-IR score and insulin/HDL-C ratio. The latter is more sensitive and is likely more convenient in the case of individuals without diabetes. The validity of two IR-related predictors in the absence of metabolic syndrome confirmed the suggestion that the mechanism of IR-related HCV is different from that of the traditional metabolic syndrome.