A43 EVALUATING THERAPEUTIC EFFICACY OF TRANS-ARTERIAL EMBOLIZATION IN PATIENTS PRESENTING POST-ENDOSCOPIC FAILURE TO MANAGE ACUTE NON-VARICEAL GASTROINTESTINAL BLEEDING
Bibliographic record
Abstract
Acute non-variceal gastrointestinal bleeding (NVGIB) is associated with a high mortality and morbidity. Endoscopy remains the initial procedure of choice for diagnosis and management. However, it is unable to achieve therapeutic hemostasis in 10–30% of these patients. Therefore, transarterial embolization (TAE) is offered as a safe and effective treatment alternative to attempt therapeutic hemostasis. Our objective was to determine: (1) efficacy of TAE in achieving therapeutic hemostasis and preventing re-bleeding post-endoscopic failure and (2) identifying what comorbidities pre-dispose patients to fail endoscopy for achieving therapeutic hemostasis. Data was collected from 32 consecutive patients who presented to the emergency department with NVGIB and received TAE after failing endoscopy and 24 consecutive patients in whom hemostasis was achieved with endoscopy. Their embolization results, clinical comorbidities, and clinical followup were retrospectively reviewed. Out of the 32 patients, 18 presented with upper, 9 with lower, and 5 with upper and lower NVGIB. Average of 6.1U of pRBCs was transfused. Immediate therapeutic hemostasis was achieved in all patients who failed endoscopy. 2 patients experienced re-bleeding and 1 patient died from intractable GIB in <1 month. Most patients had 4 or more clinical comorbidities such as Type II diabetes, coronary artery disease, cirrhosis, and hypertension. 14 patients were on chronic anticoagulation. 18/32 patients had a prior history of NVGIB. In the control population of 24 patients where therapeutic hemostasis was achieved with endoscopy, we found that only 1/24 patients had prior episodes of NVGIB. An average of 1.6 pRBCs was transfused in the control population at the time of presentation. Also, the overall incidence of CAD, cirrhosis, and HTN was lower in the control population. Trans-arterial angiographic embolization is an effective treatment to achieve therapeutic hemostasis and prevent re-bleeding in patients presenting with post-endoscopic failure to manage acute NVGIB. Presence of multiple comorbidities and prior history of acute NVGIB tends to pre-dispose patients to endoscopic failure in managing NVGIB. None
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".