Summary of findings for the main comparison. Surgical portosystemic shunts compared to transjugular intrahepatic portosystemic shunt (TIPS) for variceal haemorrhage.
| Surgical portosystemic shunts compared to transjugular intrahepatic portosystemic shunt (TIPS) for variceal haemorrhage in people with cirrhotic portal hypertension | ||||||
| Patient or population: people with cirrhotic portal hypertension Setting: health institutions in USA Intervention: surgical portosystemic shunts Comparison: transjugular intrahepatic portosystemic shunt (TIPS) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with TIPS | Risk with Surgical portosystemic shunts | |||||
| All‐cause mortality at 30 days | Study population | RR 0.94 (0.44 to 1.99) | 496 (4 RCTs) | ⊕⊝⊝⊝ Very low a b c d | ‐ | |
| 178 per 1000 | 167 per 1000 (78 to 354) | |||||
| All‐cause mortality at 5 years | Study population | RR 0.61 (0.42 to 0.90) | 496 (4 RCTs) | ⊕⊝⊝⊝ Very low a b c d | ‐ | |
| 551 per 1000 | 336 per 1000 (231 to 496) | |||||
| Number of participants with Variceal rebleeding episodes at 30 days | Study population | RR 0.18 (0.07 to 0.49) | 496 (4 RCTs) | ⊕⊝⊝⊝ Very low a c d | ‐ | |
| 117 per 1000 | 21 per 1000 (8 to 58) | |||||
| Number of participants with reintervention at 5 years | Study population | RR 0.13 (0.06 to 0.28) | 496 (4 RCTs) | ⊕⊝⊝⊝ Very low a c d | ‐ | |
| 518 per 1000 | 67 per 1000 (31 to 145) | |||||
| Irreversible shunt occlusion at 5 years | Study population | RR 0.14 (0.04 to 0.51) | 496 (4 RCTs) | ⊕⊝⊝⊝ Very low a b c d | ‐ | |
| 271 per 1000 | 38 per 1000 (11 to 138) | |||||
| Number of participants with encephalopathy at 5 years | Study population | RR 0.56 (0.27 to 1.16) | 496 (4 RCTs) | ⊕⊝⊝⊝ Very low a b c d | ‐ | |
| 385 per 1000 | 215 per 1000 (104 to 446) | |||||
| Health‐related quality of life | See comment | See comment | ‐ | 210 (2 RCTs) | ‐ | One trial provided data on health‐related quality of life with median score, while the other trial provided data on health‐related quality of life in a narrative way. Both studies appear to suggest improved health‐related quality of life in people who received surgical shunts compared with TIPS. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised clinical trial; RR: risk ratio; TIPS: transjugular intrahepatic portosystemic shunt | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect | ||||||
aDowngraded one level for risk of bias due to lack of blinding. bDowngraded one level for inconsistency due to significant heterogeneity. cDowngraded two levels for imprecision due to small sample size and few events. dDowngraded one level for publication bias due to few trials reporting outcome.