A251 ISOLATED GASTRIC VARICES DISGUISING AS RECURRENT UPPER GASTROINTESTINAL BLEED IN A CIRRHOTIC PATIENT
Bibliographic record
Abstract
Isolated gastric varices (IGV) represent an uncommon condition in cirrhotic patients. We describe a case of IGV disguising as recurrent upper gastrointestinal bleed (UGIB) in a cirrhotic patient. Describe a case of IGV presenting as recurrent UGIB. Case report Case: A 57 year-old man presented with an upper gastrointestinal bleed. This patient is known for cirrhosis, hypertension, diabetes mellitus, obstructive sleep apnea and obesity. He left against medical advice, reconsulting with rebleeding (hemoglobin (Hb) of 42g/L), and altered mental status requiring intubation. IV crystalloid and blood transfusion were given along with ceftriaxone, pantoprazole and somatostatin. An initial upper endoscopy (EGD) showed a large 5x6cm non-mobile clot in the fundus with no evidence of varices. A second look EGD showed no new findings and no varices were noted. A CT angiography (CTA) was negative apart from hepatosplenomegaly. The next day, hematochezia recurred with drop in Hb to 62 g/L. A third EGD noted brisk blood flow from the cardia/fundus with no clear source. A repeat CTA was normal. An endoscopic ultrasound (EUS) showed isolated gastric varices (IGV). A transjugular intrahepatic portosystemic shunt (TIPS) with embolization was performed. Post TIPS, the patient did not rebleed. The patient described above was bleeding from an isolated gastric varices (IGV1 as per Sarin et al. classification). 20% of patients with portal hypertension develop gastric varices, in whom only 8% are IGV1.1 Multiple studies have demonstrated the superiority of EUS compared to EGD in the detection rate of gastric varices. It is likely due to a poorer sensitivity of EGD in the detection of small gastric varices as well as misdiagnosing them as thickened gastric folds.2,3 It is important to identify accurately the source of bleeding as gastric varices are typically associated with more severe bleeding episodes than esophageal varices, as well as a higher risk for rebleeding and a high mortality. Fundal varices have significantly higher bleeding incidence (78% for IGV1).1 Our patient’s acute variceal bleed was treated with TIPS. Placement of TIPS has been shown to be very effective at controlling the episode of active bleeding, achieving a hemostatic rate as high as 90–100%, with a moderate risk of rebleeding (16–41%).3 However, as per Baveno VI recommendations, TIPS is second line therapy and is indicated when endoscopy guided cyanoacrylate injection fails. Hence, EUS plays an important role in diagnosis as well as in the management of isolated gastric varices. Submucosal gastric varices 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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
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".