OWE-5 Carvedilol vs. endoscopic band ligation for variceal bleeding secondary prophylaxis; long-term RCT follow-up
Bibliographic record
Abstract
Introduction Carvedilol reduces rates of variceal bleeding and rebleeding by lowering portal pressure. However, an associated pleotropic survival benefit has been proposed. We aim to investigate further by undertaking long-term follow-up of a multicentred randomised control trial. Methods The index study randomised 64 cirrhotic patients with clinically confirmed acute oesophageal variceal bleeding between June 2006 and December 2011 to receive either carvedilol or endoscopic band ligation (EBL).1 We reviewed electronic patient records for all patients up to 31/04/2020 and updated the previously defined clinically relevant outcomes. Results Of those randomised, 26 out of 33 participants received carvedilol in the follow-up period and 28 out of 31 attended for regular EBL sessions. There were no significant differences in baseline characteristics between groups. Mean follow-up for all participants was 2217 days. The mean duration of carvedilol administration was 1267 days. On intention to treat analysis, there was a trend towards improved survival in the carvedilol group, but this did not reach statistical significance (p=0.09). However, on per-protocol analysis, carvedilol administration was significantly associated with improved long-term survival (p<0.01), as well as fewer liver related deaths (4% vs 29%, p=0.02, OR=0.1) and fewer participants experiencing a hospital admission with decompensated liver disease (11% vs 50%, p<0.01, OR=0.13) compared to the EBL group, respectively. There were no statistically significant differences in other adverse outcomes between carvedilol and EBL groups, including variceal rebleeding (39% vs 32%, p=0.78, OR=1.3). Conclusion Following an acute variceal bleed in cirrhotic patients, carvedilol is associated with survival benefit and fewer hospital admissions. Further studies are needed to validate this finding and explore the potential benefit in other patient groups. Reference Stanley AJ, Dickson S, Hayes PC, et al. Multicentre randomised controlled study comparing carvedilol with variceal band ligation in the prevention of variceal rebleeding. J Hepatol. 2014;61(5):1014-1019.
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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 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.007 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.013 | 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".