Effects of shunt embolization on hepatic encephalopathy recurrence in patients with major portosystemic shunts: A systematic review and meta‑analysis.

This study addresses the effects of shunt embolization on the recurrence of hepatic encephalopathy (HE) in patients with major portosystemic shunts. MEDLINE via PubMed, Google Scholar, and Scopus was searched to find the relevant full-text articles published from inception until August 2024. The primary outcome was the degree of HE or mental state change determined by the West-Heaven classification system. Dichotomous data were compared using odds ratios (OR). 95% confidence (CI) intervals were provided for each outcome in the report. The random-effects model was used to analyze the data. Trim and fill, Egger's regression and funnel plot were employed to evaluate publication bias in this body of literature. A total of 7 articles and 254 patients were included in the present meta-analysis. It was found that shunt embolization significantly reduced the recurrence of HE in patients with portosystemic shunts due to liver cirrhosis. Overall analysis showed that the pooled OR was 0.253 and the overall heterogeneity of the data was substantial (95% CI: 0.117-0.550, =60.52% and P=0.001). The funnel plot was reasonably symmetrical and no study was trimmed to either side of the mean. Begg's (P=0.229) and Egger's tests (P=0.273) showed no significant risk of publication bias. Quality assessment showed that the majority of the included studies were of low quality. In conclusion, the present meta-analysis indicates that shunt embolization after portosystemic shunt significantly reduces the recurrence of HE in patients with liver cirrhosis. However, the findings should be interpreted with caution due to the low quality and low number of the included studies. Future research should prioritize higher-quality trials to validate these results and explore long-term outcomes.