Dedicated Versus Generic ePTFE-covered Stent-grafts for Transjugular Intrahepatic Portosystemic Shunt in Decompensated Cirrhosis: A Systematic Review and Meta-analysis of Overt Hepatic Encephalopathy and Shunt Dysfunction

Purpose To estimate the pooled sub-distribution hazard ratio (sHR) of overt hepatic encephalopathy (OHE) and shunt dysfunction in patients with decompensated cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) using dedicated stent‑grafts (DSG) versus generic stent‑grafts (GSG), and to compare their estimated 1-year event risk, relative risk (RR), and risk difference (RD). Materials and Methods Following PRISMA guidelines, major biomedical databases were searched for retrospective studies including adults with decompensated cirrhosis undergoing TIPS with DSG or GSG. Pooled estimates for sHR, one‑year cumulative incidence, RR, and RD for OHE and shunt dysfunction were calculated. Results The pooled estimated 1-year event risk of OHE was 14.3% (95% CI: 7.2–26.4%; I 2 = 85%) with DSG and 17.4% (95% CI: 8.1–33.4%; I 2 = 91%) with GSG, with no significant subgroup difference ( p = 0.611). The RR for OHE with DSG versus GSG was 0.81 (95% CI: 0.51–1.28; p = 0.37; I 2 =55%), the RD was − 0.03 (95% CI: −0.13 to 0.06; p = 0.45; I 2 = 82%), and the pooled sHR was 0.69 (95% CI: 0.13–3.66; p = 0.44; I 2 = 78%), none reaching statistical significance. The estimated 1-year event risk of shunt dysfunction was 5.2% (95% CI: 2.6–10.2%; I 2 = 63%) with DSG and 10.7% (95% CI: 7.8–14.7%; I 2 = 39%) with GSG, with no significant subgroup difference ( p = 0.080). DSG was associated with lower shunt dysfunction risk, with RR 0.41 (95% CI: 0.26–0.66; p = 0.0002; I 2 = 0%), RD − 0.06 (95% CI: − 0.09 to − 0.03; p < 0.0001; I 2 = 0%), and sHR 0.32 (95% CI: 0.17–0.59; p < 0.02; I 2 = 0%). Conclusion DSG use in TIPS was associated with significantly lower shunt dysfunction risk compared with GSG, while OHE risk does not differ between stent types.