Effectiveness of retrograde transvenous obliteration for primary prophylaxis of gastric variceal bleeding
Bibliographic record
Abstract
Background: Retrograde transvenous obliteration is an endovascular interventional radiology procedure demonstrating safety and efficacy for secondary prophylaxis in high-risk gastric varices. However, its efficacy as primary prophylaxis is uncertain. We conducted a systematic review and case series to evaluate the utility of this technique. Methods: A literature search utilized EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. Inclusion criteria involved single technique obliteration, known varices, and exclusively primary prophylaxis. The primary outcome was gastric variceal bleeding, with secondary outcomes of technical success, variceal eradication, adverse events, and mortality. A retrospective case series of nine patients who underwent primary prophylaxis at our North American centre was also conducted. Results: Of the 842 articles retrieved, 69 were eligible for full-text review, with the 9 studies included in the final analysis involving balloon-occluded, but not plug-assisted or coil-assisted, techniques. Only 2/9 studies involved comparator groups, with a single prospective non-randomized trial, and there was a high risk of bias in 8/9 studies. The technical success rate of the balloon-occluded obliteration technique ranged from 82% to 100%, and the variceal eradication rate ranged from 88% to 100%. In comparative studies, patients had decreased variceal bleeding and bleeding-related mortality compared with control cohorts. Our case series demonstrated a 78% survival rate with no variceal bleeding. Post-procedure ascites and worsening esophageal varices ranged from 0-55% to 11-80%, respectively. Conclusion: This review summarizes evidence regarding the efficacy of retrograde transvenous obliteration, with available studies demonstrating a high success rate in eradicating varices and preventing bleeding-associated mortality, albeit with concerns of overall quality of existing literature.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".