Effect of different diameter stents on clinical outcomes of TIPS for variceal rebleeding: A multicenter clinical study

Abstract Background Performing transjugular intrahepatic portosystemic shunt with different diameter stents leads to different portal pressure gradients and clinical outcomes. However, which diameter is more beneficial is unclear. This study aimed to compare the efficacy of using 6-, 8-, and 10-mm stents in the prevention of variceal rebleeding among patients with advanced cirrhosis. Methods This retrospective study included patients who underwent transjugular intrahepatic portosystemic shunt across six medical centers between January 2010 and June 2020. The primary endpoint was death; secondary endpoints included rebleeding, overt hepatic encephalopathy, and shunt dysfunction. Propensity score matching was performed among stent diameter groups. Results Overall, 1,688 patients were included in the study; 6-, 8-, and 10-mm diameter stents were used in 95, 1504, and 89 patients, respectively. As for survival, only the 8-mm group had a lower mortality rate than the 10-mm group (56.3% vs. 59.4%; p = 0.029). The 6-mm group had a higher rebleeding rate than those in the 8- and 10-mm groups (62.5% vs. 38.4% and 22.0%, respectively; both p < 0.001). The 6- and 8-mm groups exhibited lower overt hepatic encephalopathy rates than that in the 10-mm group (36.1% vs. 50.0%, p = 0.029; 42.4% vs. 50.0%, log-rank p = 0.021). The 6- and 8-mm groups exhibited higher shunt dysfunction rates than that in the 10-mm group (45.6% vs. 17.6%, p = 0.005; 32.24% vs. 17.61%, p = 0.024). Conclusions Compared with 6- and 10-mm diameters, transjugular intrahepatic portosystemic shunt with 8-mm stents is optimal to balance rebleeding prevention and overt hepatic encephalopathy risk reduction for patients with advanced cirrhosis; overall survival was not impacted.