EFFICACY OF ENDOSCOPIC TREATMENTS FOR ACUTE ESOPHAGEAL VARICEAL BLEEDING IN CIRRHOTICS: SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Aims: Most guidelines recommend and consider the use of ligation and vasoactive drugs as the first line therapy and grade A evidence for acute variceal bleeding (AVB), although Western studies about this issue are lacking. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy of endoscopic treatments for AVB. Methods: Systematic review and meta-analysis of RCT evaluating endoscopic treatments for AVB in adult patients with cirrhosis. Trials that included patients with hepatocellular carcinoma or other malignancies, use of portocaval shunts or esophageal resection, use of balloon tamponade as first bleeding control measure, or that received placebo or elective treatment in one study arm were excluded. Results: 8382 publications were searched, and 36 RCT with 3593 patients included. Ligation was associated with a significant improvement in bleeding control [relative risk (RR) 1.08; 95% confidence interval (CI) 1.02 – 1.15] when compared to sclerotherapy. Sclerotherapy combined with vasoactive drugs showed higher efficacy in active bleeding control compared to sclerotherapy alone [RR 1.17; 95% CI 1.10 – 1.25]. The combination of ligation and vasoactive drugs was not superior to ligation alone in terms of overall rebleeding [RR 2.21; 95% CI 0.55 – 8.92] and in-hospital mortality [RR 1.97; 95% CI 0.78 – 4.97]. Other treatments did not generate meta-analysis. Conclusions: This study showed that ligation is superior to sclerotherapy, although with moderate heterogeneity. The combination of sclerotherapy and vasoactive drugs was more effective than sclerotherapy alone. Although current guidelines recommend the combined use of ligation with vasoactive drugs in the treatment of esophageal variceal bleeding, this study failed to demonstrate the superiority of this combined treatment.
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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 | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.030 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".