Timing of endoscopy in patients with acute variceal bleeding in cirrhosis: an updated systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Endoscopy is a critical tool in the management of acute variceal bleeding (AVB). However, the optimal timing for its implementation remains controversial, with varying recommendations across different clinical guidelines. This study aims to evaluating the impact of endoscopy timing on patient outcomes. METHODS: PubMed, the Cochrane Library, and Embase were searched from the earliest available publication to January 31, 2024. Both fixed-effect and random-effect models were employed to calculate the odds ratio (OR) and 95% confidence intervals (CIs), based on the levels of heterogeneity. Newcastle-Ottawa Scale was used to assess the quality of each included studies. The mortality, incidence of rebleeding and other secondary outcomes were compared between urgent and early endoscopy groups. Subgroup analysis was performed based on the endoscopy time defined in each included studies and the reporting time of primary outcomes. The publication bias was examined through Egger’s test and Begg’s test. RESULTS: Our analysis showed no significant difference in overall mortality (OR = 0.99, 95% CI, 0.60–1.62, P = 0.96) and rebleeding (OR = 1.06, 95% CI, 0.77–1.47, P = 0.71) as well as secondary outcomes between the two groups. Subgroup analysis indicated that the mortality in the 6–24 h endoscopy group was significantly lower than in the < 6 h endoscopy group (OR = 2.05, 95% CI, 1.29–3.26, P = 0.002). However, no statistical difference between the other groups. CONCLUSION: Endoscopy performed within 6 h might be associated with higher mortality. Furthermore, urgent and early endoscopy did not significantly affect other outcomes in AVB patients. Therefore, the timing for endoscopy would be more appropriate based on each patient’s condition within 24 h.
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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 | 0.008 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.033 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| 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".