TIPS combined with embolization reduces rebleeding risk in patients with decompensated liver cirrhosisTIPS Combined With Embolization Reduces Rebleeding in Liver Cirrhosis

European journal of gastroenterology & hepatology Published October 6, 2026 Study authors: Ma Xiongtao, Yu Xinyan, Wu Qingping, Chen Yu, Jiang Ting, Wang Lei, Tao Qinghua PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider TIPS with embolization to reduce rebleeding and hepatic encephalopathy in patients with gastric variceal bleeding.

This meta-analysis evaluated the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with embolization compared to TIPS alone in 3079 patients with decompensated liver cirrhosis and esophageal or gastric variceal bleeding. The primary finding was a significantly lower overall rebleeding rate in the combined therapy group (risk ratio 0.67; 95% CI 0.57-0.79; P < 0.001).

Subgroup analyses revealed that the reduction in rebleeding was particularly pronounced in patients with gastric variceal bleeding (risk ratio 0.50; 95% CI 0.34-0.74; P < 0.001). However, no significant difference in rebleeding was observed in the isolated esophageal variceal bleeding subgroup (risk ratio 0.83; 95% CI 0.51-1.35; P = 0.46). Additionally, the incidence of hepatic encephalopathy was lower in the combined group (risk ratio 0.82; 95% CI 0.73-0.91; P < 0.001).

Survival rates showed no significant difference between the intervention and control groups (risk ratio 1.00; 95% CI 0.97-1.03; P = 0.94). While the combination therapy appears to reduce rebleeding and hepatic encephalopathy, the lack of difference in survival and the lack of significance in isolated esophageal cases suggest that the clinical benefit may be specific to certain anatomical presentations of variceal bleeding.

Researchers analyzed data from over 3,000 patients with liver cirrhosis who experienced bleeding from enlarged veins in the esophagus or stomach. The study compared two treatments: a procedure called TIPS alone versus TIPS combined with embolization.

The results showed that patients who received both TIPS and embolization had lower overall rates of rebleeding compared to those who received only TIPS. This reduction was especially notable for those with gastric variceal bleeding. Additionally, the combined treatment was linked to a lower incidence of hepatic encephalopathy, a condition that affects brain function due to liver issues.

While the combined treatment showed promise in reducing rebleeding and certain complications, the survival rates were similar between both groups. Because this was a meta-analysis of existing data, the results provide a broad overview but do not account for individual patient differences. Patients should discuss these specific treatment options with their doctors to determine the best plan for their specific condition.

What this means for you:

Combining embolization with TIPS may reduce rebleeding and certain complications in patients with liver cirrhosis.

Common questions

What is the benefit of adding embolization to TIPS?

Adding embolization to the TIPS procedure was linked to a lower overall rebleeding rate compared to using TIPS alone. It also showed a lower incidence of hepatic encephalopathy, which is a common complication of liver disease. These findings are based on a review of 3,079 patients.

Does this treatment help with all types of liver bleeding?

The study showed a significant reduction in rebleeding for patients with gastric variceal bleeding. However, for patients with isolated esophageal variceal bleeding, there was no significant difference in rebleeding rates between the two treatment methods.

Does the combined treatment improve survival rates?

The study found no significant difference in survival rates between patients who received TIPS alone and those who received TIPS combined with embolization. While the combined treatment helped manage specific complications, it did not change the overall survival outcome in this analysis.

Study Details

Study typeMeta analysis

Sample sizen = 3,079

EvidenceLevel 1

PublishedNov 2026

PMID42765290

View Original Abstract ↓

BACKGROUND: This study aimed to evaluate whether transjugular intrahepatic portosystemic shunt (TIPS) combined with embolization could further improve efficacy for patients with decompensated liver cirrhosis complicated with esophageal and gastric variceal bleeding. METHODS: We searched PubMed, Web of Science, Embase, and Cochrane Library, for all relevant randomized controlled trials and cohort studies up to March 2025. Statistical results were evaluated using risk ratios and 95% confidence intervals (CIs). RESULTS: A total of 14 studies involving 3079 patients were included. The statistical results showed that the rebleeding rate in the TIPS combined with embolization group was lower than that in the TIPS alone group (risk ratios = 0.67; 95% CI = 0.57-0.79; P < 0.001), and the same result was observed only in the subgroup of patients with gastric variceal bleeding (risk ratios = 0.50; 95% CI = 0.34-0.74; P < 0.001). There was no significant difference between the groups in patients with isolated esophageal variceal bleeding (risk ratios = 0.83; 95% CI = 0.51-1.35; P = 0.46). In addition, the incidence of hepatic encephalopathy in the TIPS combined with embolization group was also lower than that in the TIPS alone group (risk ratios = 0.82; 95% CI = 0.73-0.91; P < 0.001), but there was no significant difference in survival rate (risk ratios = 1.00; 95% CI = 0.97-1.03; P = 0.94). CONCLUSION: Compared with TIPS alone, the combined treatment showed a trend toward lower rebleeding and hepatic encephalopathy, yet survival appeared similar between the two groups.

TIPS combined with embolization reduces rebleeding risk in patients with decompensated liver cirrhosisTIPS Combined With Embolization Reduces Rebleeding in Liver Cirrhosis

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TIPS combined with embolization reduces rebleeding risk in patients with decompensated liver cirrhosisTIPS Combined With Embolization Reduces Rebleeding in Liver Cirrhosis

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