Cyanoacrylate for Treatment of Acute Variceal Bleeding: A Systematic Review
Bibliographic record
Abstract
Purpose: Acute gastrointestinal bleeding from gastric variceal bleeding is associated with significant morbidity and mortality. Role of cyanoacrylate has been reported in several studies. We performed a systematic review to evaluate the effectiveness and safety of cyanoacrylate injection for treatment of acute gastric variceal bleed. Methods: Pubmed, Embase, CINHAL, the Cochrane Library and abstracts from major conference proceedings were searched for relevant articles (search date 6/12). Retrospective or prospective studies assessing the effectiveness and safety of cyanoacrylate injection for therapy of acute gastric variceal bleed in adult patients were included. All studies with sample size of 25 patients or greater were included. Data on the patient characteristics, etiology of liver disease, outcomes of the procedure (immediate control of bleeding, rate of rebleeding, failure of endoscopic therapy) and complications were extracted. Two reviewers independently extracted the data. Results: Nineteen studies met the inclusion criteria (N=1,217). The studies were performed in India, Korea, Spain, Brazil, Germany, Thailand, Japan, Egypt, USA, Canada, China, UK, Taiwan, Italy and Pakistan. Seven studies were prospective studies, and 12 were retrospective. Sample sizes ranged from 29-100 patients. The mean age of the patients ranged from 19-80 yrs. Etiology of liver disease was alcoholic or viral hepatitis in most of the studies. Hepatocellular carcinoma was present in 17-80% of patients (193pts, 7 studies). Severity of liver disease (Child-Pugh score) was as follows: A 13-40%, B 34-54%, C 18-53%. Grade of varices (Sarin classification) was as follows: GOV 1 10-67%, GOV 2 19-80%, IGV 1 2-44%, IG2 2-13%. The dose of the cyanoacrylate ranged from 0.5 to 1.5 ml. Dose of lipoidal used ranged from 0.5ml to 1.5 ml. The numbers of injections per session ranged from 1-5. In all studies, it was injected during the time of the procedure. Immediate control of bleeding was achieved in 82-100% of patients. Rebleeding occurred in 10-30 % of patients. Treatment failure occurred in 6-25% of cases. Eradication of the varices was achieved in 36-80%. Mean number of sessions to achieve eradication ranged from 1.3-2.7 sessions. Complications occurred in 4-35% of patients. These included fever, infectious causes, pulmonary embolism, post injection ulcers, cast extrusion, chest pain and thrombosis. Clogging of the injection needle was reported in 3 studies. Conclusion: Cyanoacrylate is a promising agent for control of acute gastric variceal bleeding. Further larger randomized studies are needed to assess its efficacy and safety.
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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 | 0.005 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.006 |
| Bibliometrics | 0.008 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".