Real–World outcomes of transjugular intrahepatic portosystemic shunt combined with embolization: A multicenter retrospective study

Background: and aims Transjugular intrahepatic portosystemic shunt (TIPS) combined with embolization (TIPS + E) in the control of variceal bleeding still remains controversial. This study aimed to explore the clinical outcomes of TIPS + E and present evidence for guideline recommendations in a real–world cohort. Methods In this multicenter retrospective cohort, 2077 cirrhotic patients received TIPS ± E (631 in TIPS alone and 1446 in TIPS + E) were enrolled between January 2010 and June 2020, with a median follow–up time of 32.5 (19.3, 56.6) months. The primary outcome was rebleeding, and the secondary outcomes were hepatic encephalopathy (HE), survival, recompensated survival (R–survival), further–decompensated rates, and post–further–decompensated survival (PFD–survival). Results The rebleeding rate was similar between TIPS and TIPS + E group (P = 0.51). TIPS + E had a trend toward decreasing HE rates comparing to TIPS alone (P = 0.20). In addition, TIPS + E significantly improved survival comparing to TIPS (P = 0.006). Besides, TIPS + E group had a significant lower further-decompensated rate than TIPS (P = 0.04). For prognosis, TIPS + E also improved R–survival (P = 0.036) and PFD–survival (P = 0.02) comparing to TIPS alone, respectively. Conclusion Based on the present real–world data, TIPS + E showed efficacy in control of rebleeding, with a trend towards decreasing HE, which significantly improved survival and prognosis compared to TIPS alone.