Supplementary Material for: Transjugular intrahepatic portosystemic shunt for portal vein cavernous transformation: a systematic review and single-arm meta-analysis

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is technically challenging in the treatment of portal vein cavernous transformation (PVCT), and there is no high-quality evidence regarding whether it is an option for patients with PVCT. We carried out a systematic review and meta-analysis to assess the feasibility and safety of TIPS for PVCT. Methods: Systematic search of PubMed, Chinese National Knowledge Infrastructure Database (CNKI), Cochrane Library, Embase and Wanfang database through December 2021 for appropriate studies reporting efficacy and safety in patients with PVCT undergoing TIPS. The main outcome included the technical successful rate, postoperative rebleeding rate, postoperative hepatic encephalopathy rate, stent patency rate, preoperative and postoperative portal pressure. Results: Ten studies including 292 patients were included. Our results showed that TIPS was technically successful in 82.97% [95% confidence interval (CI): 77.14%-88.41%, P=0.297] with low heterogeneity (I2=18.39%, P=0.279). Postoperative rebleeding occurred in 9.56% (95% CI: 4.55%-16.77%, P=0.073) with moderate heterogeneity (I2=46.45%, P=0.06). Postoperative hepatic encephalopathy occurred in 18.55% (95%CI: 9.23%-27.05%, P=0.343) with moderate heterogeneity (I2=48.62%, P=0.049). Stent patency during follow-up was in 78.43% (95%CI: 70.74%-85.20%, P=0.805) with low heterogeneity (I2=0%, p=0.654). Postoperative portal pressure significantly reduced (WMD=12.79mm Hg, 95% CI: 12.09-13.48mm Hg, P＜0.00001) with high heterogeneity (I2 = 61.4%, P=0.02). Both Begg test and funnel plot showed that there was no significant publication bias. Conclusions: TIPS is feasible and safe in patients with PVCT and PVCT should not be considered an absolute contraindication to TIPS.

背景：经颈静脉肝内门体分流术（Transjugular intrahepatic portosystemic shunt, TIPS）在治疗门静脉海绵样变性（Portal vein cavernous transformation, PVCT）时具有较高技术难度，目前尚无高质量证据表明其可作为门静脉海绵样变性患者的治疗选择。本研究开展系统评价与meta分析，旨在评估经颈静脉肝内门体分流术治疗门静脉海绵样变性的可行性与安全性。
方法：检索截至2021年12月的PubMed、中国知网（Chinese National Knowledge Infrastructure Database, CNKI）、Cochrane图书馆、Embase及万方数据库，筛选报道接受经颈静脉肝内门体分流术治疗的门静脉海绵样变性患者疗效与安全性的合格研究。主要结局指标包括技术成功率、术后再出血率、术后肝性脑病发生率、支架通畅率及术前与术后门静脉压力。
结果：最终纳入10项研究，共292例患者。结果显示，经颈静脉肝内门体分流术的技术成功率为82.97%[95%置信区间（Confidence Interval, CI）：77.14%~88.41%，P=0.297]，异质性较低（I²=18.39%，P=0.279）。术后再出血发生率为9.56%（95%CI：4.55%~16.77%，P=0.073），异质性中等（I²=46.45%，P=0.06）。术后肝性脑病发生率为18.55%（95%CI：9.23%~27.05%，P=0.343），异质性中等（I²=48.62%，P=0.049）。随访期间支架通畅率为78.43%（95%CI：70.74%~85.20%，P=0.805），异质性较低（I²=0%，P=0.654）。术后门静脉压力显著降低（加权均数差=12.79mmHg，95%CI：12.09~13.48mmHg，P＜0.00001），异质性较高（I²=61.4%，P=0.02）。Begg检验与漏斗图分析均显示，本研究无显著发表偏倚。
结论：经颈静脉肝内门体分流术治疗门静脉海绵样变性患者具有可行性与安全性，门静脉海绵样变性不应被视为经颈静脉肝内门体分流术的绝对禁忌证。