Abstract No. 579 BRTO vs. TIPS for gastric variceal bleeding secondary to portal hypertension: systematic review and meta-analysis

To systematically review and analyze the current evidence comparing Balloon-occluded retrograde transvenous obliteration (BRTO) to transjugular intrahepatic portosystemic shunt (TIPS) procedure in managing gastric variceal bleeding secondary to portal hypertension. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science for relevant studies published between 1970 through August 2018. Screening of identified studies was done duplicately by independent reviewers using a piloted online platform (Covidence, Melbourne, Victoria, Australia). Data extraction as well as risk of bias assessment were performed by independent reviewers using a standardized extraction form. Data cleaning and analysis were performed by a third reviewer. OpenMeta [Analyst] software was utilized for statistical analysis. We identified 1755 studies that were screened and we eventually included 6 retrospective cohort studies. The overall risk of bias in this body of literature was low to moderate. 588 patients were analyzed (373 underwent BRTO and 215 underwent TIPS). The overall mean age was 58, while it was 58.6 for BRTO patients and 55.6 for TIPS patients (years). 26% of BRTO and 28.8% of TIPS patients had pre-procedural ascites. The baseline MELD and Child-Pugh scores were 13.6 and 7.5 for BRTO and 13.1 and 7.6 for TIPS patients, respectively. BRTO was associated with a lower incidence of hepatic encephalopathy (OR = 0.098, 95% CI = 0.03 to 0.38) but a higher rate of worsening ascites (OR = 3.96, 95% CI = 1.29 to 12.18) compared to TIPS. The analysis results for the outcomes of re-bleeding rates and technical success for BRTO versus TIPS were inconclusive and not statistically significant. BRTO is associated with lower rates of post-procedural hepatic encephalopathy but higher rates of worsening ascites compared with TIPS in managing gastric variceal bleeding. However, the current body of evidence is inconclusive regarding re-bleeding rates and technical success.