Early Transjugular Intrahepatic Portosystemic Shunt Creation Compared to Endoscopy With Pharmacotherapy in the Management of Variceal Rebleeding in Cirrhotic Patients: A Comprehensive Systematic Review and Meta-Analysis: Presidential Poster Award
Bibliographic record
Abstract
Introduction: The use of early or rescue transjugular intrahepatic portosystemic shunt (TIPS) has been evaluated in cirrhotic patients with a history of variceal bleeding. In this study, we aimed to perform a systematic review and meta-analysis of studies investigating the efficacy and safety of early TIPS in the management of variceal bleeding as well as comparing the use of early compared to rescue TIPS. Methods: Medical electronic databases were queried for clinical studies in which TIPS creation was compared with endoscopy and pharmacotherapy treatment in cirrhotic patients with a history of variceal bleeding. Search results were screened against predefined eligibility criteria and data were extracted to a standard data extraction form. Meta-analysis was performed using Comprehensive Meta-Analysis software and the risk of bias of included studies was assessed using the Cochrane tool and modified Newcastle-Ottawa scale Results: Thirty-four studies that enrolled 2876 cirrhotic patients (n=1453 in the TIPS group and n=1423 in the endoscopy with pharmacotherapy group) were included. Overall analysis displayed significantly reduced re-bleeding, odds ratio (OR) = 0.29, 95% confidence interval (CI) [0.22-0.38], p< 0.0001) and bleeding-related death (OR= 0.28, 95% CI [0.18-0.44], p< 0.0001) in the TIPS group. There was no significant difference in all-cause mortality between all TIPS and endoscopy with pharmacotherapy (OR= 0.93, 95% CI [0.74-1.16], p= 0.52) and there was an increased incidence of hepatic encephalopathy (OR= 1.80, 95% CI [1.41-2.28], p< 0.0001) in the TIPS group (pooled analysis of both early and rescue TIPS). Early use of TIPS did not reveal any differences in hepatic encephalopathy (OR= 1.27, 95% CI [0.9-1.7], p= 0.13) and showed a decreased mortality in high risk patients (Child-Pugh class C, Child-Pugh class B with active bleeding at endoscopy, and hepatic venous pressure gradient [HVPG] ≥20 mm Hg) when compared to rescue TIPS. Conclusion: TIPS creation decreases rebleeding at the cost of increased hepatic encephalopathy with no survival benefit. Early TIPS creation may confer better clinical outcomes in terms of comparable hepatic encephalopathy and improved survival in high-risk patients when compared to rescue TIPS.
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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 | 0.012 | 0.021 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.028 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".