Comparative Efficacy of Treatment Options for the Prevention of Post-TIPS Hepatic Encephalopathy: A Systematic Review and Network Meta-analysis

Authors

  • Zohaib Ahmed Department of Internal Medicine, University of Toledo, Toledo, Ohio, USA
  • Mona Hassan Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, USA
  • Syeda Faiza Arif University of Toledo Medical Center, Toledo, Ohio, USA
  • Muhammad Aziz Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, USA
  • Umair Iqbal Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
  • Ahmad Nawaz Division of Internal Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
  • Umer Farooq Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Chicago, Illinois, USA
  • Wade Lee Smith University of Toledo Libraries, University of Toledo, Toledo, Ohio, USA
  • Joyce Badal University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
  • Anas Renno Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, USA
  • Toseef Javaid Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, USA
  • Ali Nawras Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, USA
  • Sammy Saab Dept. of Medicine and Surgery at the David Geffen School of Medicine at UCLA (University of California Los Angeles), Los Angeles, California, USA

DOI:

https://doi.org/10.15403/jgld-4508

Keywords:

transjugular intrahepatic portosystemic shunt, variceal bleeding, hepatic encephalopathy

Abstract

Background and Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is often used in patients with cirrhosis to manage portal hypertension-related complications. Unfortunately, 35-50% of patients develop overt hepatic encephalopathy (HE) after TIPS. However, data on lactulose and rifaximin to prevent post-TIPS HE is limited. Therefore, we aimed to perform a network meta-analysis to investigate the efficacy of multiple pharmacological regimens in the prevention of post-TIPS HE.

Methods: A comprehensive search strategy to identify reports of studies of rifaximin use on post-TIPS hepatic encephalopathy was constructed using truncated keywords, phrases, and subject headings developed in Embase. This strategy was translated to MEDLINE, Cochrane Central Register of Controlled Trials, and the Web of Science Core Collection, with all searches performed on 10 February 2022. No publication date or language limits were used.

Results: The initial search identified 72 studies, and 56 studies were screened after removing duplicates. Five studies, two randomized controlled trials (RCTs) and three retrospective studies, met our inclusion criteria and were included in the final analysis. A total of 840 patients were included, with 65% male. Our meta- analysis did not find a statistically significant difference between lactulose vs placebo/no prophylaxis, nor rifaximin vs placebo/no prophylaxis, nor rifaximin plus lactulose vs placebo/no prophylaxis in the reduction of post-TIPS HE.

Conclusions: Rifaximin alone, lactulose alone, and rifaximin plus lactulose did not significantly reduce the development of post-TIPS HE. Based on the P-scores of the three treatment groups, the combination of rifaximin plus lactulose showed the most promising trend towards preventing post-TIPS HE. More studies, especially large RCTs, are warranted.

Downloads

Published

2023-04-01

How to Cite

1.
Ahmed Z, Hassan M, Arif SF, Aziz M, Iqbal U, Nawaz A, Farooq U, Smith WL, Badal J, Renno A, Javaid T, Nawras A, Saab S. Comparative Efficacy of Treatment Options for the Prevention of Post-TIPS Hepatic Encephalopathy: A Systematic Review and Network Meta-analysis. JGLD [Internet]. 2023 Apr. 1 [cited 2026 Feb. 10];32(1):70-6. Available from: https://jgld.ro/jgld/index.php/jgld/article/view/4508

Issue

Vol. 32 No. 1: March 2023

Section

Systematic Review and Meta-Analysis