A96 WHICH IS THE BEST ENDOSCOPIC HEMOSTATIC THERAPY FOR DIEULAFOY’S LESIONS? A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Abstract Background Dieulafoy’s lesion (DL) is an uncommon but serious cause of significant gastrointestinal bleeding, typically treated with various endoscopic therapies. Aims This systematic review and meta-analysis is the first to evaluate the effectiveness and safety of endoscopic hemostatic therapies for treating DL, including endoscopic band ligation (EBL), endoscopic hemoclip placement (EHP), over-the-scope clips (OTSC), thermocoagulation, topical hemostatic agents (THA) and injection methods (epinephrine, sclerosant). Methods We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials up to March 2024, including randomized controlled trials (RCTs) and observational cohort studies comparing different endoscopic techniques for DL. Two authors conducted study selection, data extraction and quality assessment independently. The primary outcome was 7-day further bleeding. Further bleeding is a composite outcome of failure to achieve immediate hemostasis and rebleeding. Secondary outcomes included failure to achieve immediate hemostasis, rebleeding, overall mortality, adverse events, and additional hemostatic therapy. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using RevMan 5.4. Heterogeneity was assessed by Chi2 (P<0.15) and I2 tests (>25%). The GRADE approach was used to assess the certainty of evidence (CoE). Results We included 7 RCTs, 4 comparative cohort studies, and 27 single-arm cohort studies from 5501 citations. Meta-analyses of EBL compared to EHP showed RRs for 7-day further bleeding in RCTs and cohort studies of 0.66, 95%CI 0.09-5.03 and RR 0.22, 95% CI0.05-0.95, respectively (very low CoE). Additionally, RR for EBL compared to thermocoagulation for 7-day further bleeding in a cohort study was 0.15, 95%CI 0.01- 2.71 (very low CoE). RRs for epinephrine injection alone compared to EBL/EHP and thermocoagulation were 4.37, 95%CI 1.43-13.33 and 10.08, 95%CI 0.63-162.0, respectively (very low CoE). Table 1 shows the results of the standard meta-analyses and proportional meta-analyses. Conclusions Epinephrine should not be used as monotherapy for the treatment of DL. Mechanical endoscopic therapies, especially EBL, appear to be an effective option for DL. Further research is needed to assess the roles of OTSC and THA in managing DL and obtain more precise estimates of the effectiveness of EBL, EHP, and thermocoagulation. Table: Outcomes in patients with DL treated with different endoscopic interventions. Funding Agencies 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 | 0.014 | 0.028 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.027 | 0.042 |
| Bibliometrics | 0.010 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 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".