OUTCOME OF ENDOSCOPIC VARICEAL LIGATION (EVL) FOR SECONDARY PROPHYLAXIS OF VARICEAL HEMORRHAGE
Bibliographic record
Abstract
Aim: Few studies have described the efficacy of EVL in children. We aimed to describe the outcomes of children treated with EVL for secondary prophylaxis following variceal hemorrhage. Methods: Children <18y with PHT and previous variceal bleed who underwent EVL for secondary prophylaxis of bleeding between 1995 and 2005 were identified and their medical charts were reviewed. Exclusion criteria included prior sclerotherapy. Information extracted included demography, diagnosis, procedure details, immediate adverse events, delayed adverse events, and long-term outcome. Varices were graded on an established 4 point scale. Presence or absence of gastropathy and gastric varices was recorded. Primary outcome was variceal rebleeding. Results: 35 children met inclusion criteria, 6 were excluded for prior injection sclerotherapy, leaving 29 patients (19 boys, 10 girls) as the study cohort. PHT was caused by portal vein (PV) thrombosis (n = 10, mean age at first banding 6.0y, 1 post-liver transplant) or hepatic disease (n = 19, 8.6y), including sclerosing cholangitis (n = 5), biliary atresia (n = 3), post-liver transplant (n = 2) and others (n = 9). 107 EVL sessions were undertaken (mean 3.7 per child). Portal hypertensive gastropathy was seen in 25 children and gastric varices in 17. Immediate bleeding occurred during 8 procedures; 2 patients required further banding and 6 patients had minimal blood loss requiring no treatment. On follow-up, 7 patients (24.1%) rebled, 1 died, 6 patients had portal-systemic shunts and 6 underwent liver transplantation. Rebleeding occurred in 4 of 10 (40%) patients with PV thrombosis and 3 of 19 (16%) patients with hepatic PHT. Kaplan-Meier survival analysis showed significant difference in time to rebleeding between patients with PV thrombosis and hepatic PHT (P < 0.05). Conclusions: The incidence of variceal rebleeding in children following EVL for secondary prophylaxis is comparable to adults; combined therapies to improve outcomes in children should be studied. Difference in outcome between PV thrombosis and hepatic PHT requires confirmation in a larger cohort.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".