Hepatology international · 2026
Coaxial stent TIPS with 5 to 8 mm controlled expansion improving overall prognosis in cirrhotic patients: a prospective cohort study with target trial emulation.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ma Li, Ma Jingqin, Yu Jiaze, Liu Yaozu, Zhou Yongjie, Yang Minjie, Yan Zhiping, Luo Jianjun, Zhang Wen
Аннотация
BACKGROUND AND AIM: Cirrhotic patients receiving trans-jugular intrahepatic portosystemic shunt (TIPS) for preventing re-bleeding may benefit from a shunt diameter of ≤ 8 mm. This study aimed to emulate a target trial comparing decompensation-free survival in patients receiving coaxial stent versus fully- or under-dilated 8 mm TIPS for preventing variceal re-bleeding.
APPROACH: Participants were recruited from a single-center, prospective, non-randomized cohort after excluding patients impossible to be assigned to the coaxial stent group. The coaxial stent consisted of a pre-implanted 5-/6 mm balloon-expandable stent with an internal 8 mm Viatorr stent. Causal inference framework was designed based on a directed acyclic graph, incorporating inverse probability weighting (IPW), doubly robust estimation by augmented IPW, mediation analysis, and E value analysis.
RESULTS: 200 patients entered into target trial emulation, with 47 (23.5%), 101 (50.5%), and 52 (26.0%) in coaxial stent, under-dilated, and fully dilated groups. Coaxial stent feasibility was demonstrated by portacaval pressure gradient adjustability (33 pairs before/after dilation: 22.8 ± 3.0 to 17.9 ± 3.1 mmHg, p < 0.001) and stability (76 pairs without intervention: 17.7 ± 4.2 to 18.5 ± 4.5 mmHg, p = 0.035, r = 0.712, ICC = 0.710). Crude (IPW-weighted) 1-year decompensation-free survival incidences were 57.7% (52.6%), 60.1% (60.0%), and 76.6% (78.9%) for fully dilated, under-dilated, and coaxial stent groups, with doubly robust analysis revealing improved prognosis in coaxial stent versus fully dilated (HR 0.54 [0.25-0.93], p = 0.026, E value = 3.108, direct effect 66.3%) and under-dilated (HR 0.63 [0.34-1.05], p = 0.070, E value = 2.553, direct effect 60.7%) groups. Coaxial stent group demonstrated significantly reduced hepatic encephalopathy risk compared with other groups (p = 0.045/0.026), while other outcomes were comparable.
CONCLUSIONS: The coaxial stent TIPS strategy could effectively achieve controlled expansion of 5-8 mm and may improve overall prognosis in cirrhotic patients with previous variceal bleeding.
APPROACH: Participants were recruited from a single-center, prospective, non-randomized cohort after excluding patients impossible to be assigned to the coaxial stent group. The coaxial stent consisted of a pre-implanted 5-/6 mm balloon-expandable stent with an internal 8 mm Viatorr stent. Causal inference framework was designed based on a directed acyclic graph, incorporating inverse probability weighting (IPW), doubly robust estimation by augmented IPW, mediation analysis, and E value analysis.
RESULTS: 200 patients entered into target trial emulation, with 47 (23.5%), 101 (50.5%), and 52 (26.0%) in coaxial stent, under-dilated, and fully dilated groups. Coaxial stent feasibility was demonstrated by portacaval pressure gradient adjustability (33 pairs before/after dilation: 22.8 ± 3.0 to 17.9 ± 3.1 mmHg, p < 0.001) and stability (76 pairs without intervention: 17.7 ± 4.2 to 18.5 ± 4.5 mmHg, p = 0.035, r = 0.712, ICC = 0.710). Crude (IPW-weighted) 1-year decompensation-free survival incidences were 57.7% (52.6%), 60.1% (60.0%), and 76.6% (78.9%) for fully dilated, under-dilated, and coaxial stent groups, with doubly robust analysis revealing improved prognosis in coaxial stent versus fully dilated (HR 0.54 [0.25-0.93], p = 0.026, E value = 3.108, direct effect 66.3%) and under-dilated (HR 0.63 [0.34-1.05], p = 0.070, E value = 2.553, direct effect 60.7%) groups. Coaxial stent group demonstrated significantly reduced hepatic encephalopathy risk compared with other groups (p = 0.045/0.026), while other outcomes were comparable.
CONCLUSIONS: The coaxial stent TIPS strategy could effectively achieve controlled expansion of 5-8 mm and may improve overall prognosis in cirrhotic patients with previous variceal bleeding.