***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Prevention of variceal bleeding , a major cause of morbidity and mortality , is an important goal in the management of patients with portal hypertension ( PHT ) . Although propranolol has been found useful in preventing the first episode of variceal bleeding ( primary prophylaxis ) in cirrhotic PHT , it has limitations which include side effects , contraindications , non-compliance and failure in some patients . Endoscopic variceal ligation ( EVL ) has not been used for primary prophylaxis . METHODS Thirty cirrhotic patients with PHT , grade III to IV oesophageal varices , hepatic venous pressure gradient > or = 12 mmHg and no prior history of upper gastrointestinal bleeding were r and omized to receive propranolol ( to reduce their pulse rate by 25 % from baseline , n = 15 ) and EVL ( weekly to fortnightly until variceal eradication , n = 15 ) . The two groups were comparable . All the patients in EVL group had variceal eradication during 3.8 + /- 2.2 sessions . RESULTS There was no major complication or interval bleeding . During a follow-up period of 17.6 + /- 4.7 months , varices recurred in three , two of which bled ( successfully treated by EVL ) . In contrast , during this period of follow up one patient in the propranolol group had variceal bleeding ( P = NS ) . Side effects of propranolol included symptomatic bradycardia requiring reduction of dose in one of 15 patients . CONCLUSIONS Although sample size in this study is small , it seems that EVL may be a good option for primary prophylaxis for variceal bleeding in patients with cirrhotic PHT ; further studies on a larger number of patients and longer follow up are required Administration of nonselective beta-blockers in prophylaxis of first variceal bleeding is not suitable for all patients . Thus , we evaluated endoscopic variceal b and ligation ( EVBL ) in primary prevention of bleeding in patients with cirrhosis and large esophageal varices . A total of 73 consecutive patients with liver cirrhosis and large esophageal varices without a history of gastrointestinal bleeding were r and omized to receive either EVBL or propranolol and were followed for up to 18 months . Forty patients underwent EVBL and 33 patients received propranolol .  Variceal bleeding occurred in 2 patients in the EVBL ( 5 % ) and in 2 patients in the propranolol group ( 6 % , NS ) . The 18 month actuarial risk for first variceal bleed was 5 % in the EVBL ( 95 % CI , 0 - 12 % ) and 20 % in the propranolol group ( 95 % CI , 0 - 49 % , NS ) . The actuarial probability of death at 18 months of follow-up was 5 % ( 95 % CI , 0 - 11 % ) in the EVBL group and 7 % ( 95 % CI , 0 - 17 % , NS ) in the propranolol arm . In conclusion , EVBL was an effective and safe alternative to propranolol in primary prophylaxis of bleeding in patients with large esophageal varices BACKGROUND The transjugular-intrahepatic-portosystemic shunt is a new interventional treatment for portal hypertension . The aim of our study was to compare the transjugular shunt with endoscopic treatment for the prophylaxis of recurrent variceal bleeding . METHODS Between March , 1993 , and March , 1996 , 126 patients with variceal bleeding were r and omly assigned either transjugular shunt ( n = 61 ) or endoscopic treatment ( n = 65 ) . Patients were followed up for a median of 14 ( IQR 8 - 25 ) months and 13 ( 8 - 25 ) months , respectively . In 31 ( 51 % ) of the shunted patients , simultaneous transjugular-variceal embolisation was done at the time of shunt placement . Endoscopic treatment consisted of sclerotherapy and /or b and ing ligation and was combined with propranolol medication . FINDINGS Technical success was achieved in all patients assigned to the shunt group . During follow-up , the cumulative 1-year variceal rebleeding rates in the shunted and endoscopically treated patients were 15 % and 41 % and the 2-year rates were 21 % and 52 % ( p = 0.001 ) , respectively . In nine ( 12 % ) patients from the endoscopic group treatment failed and the patients received the transjugular-shunt treatment . A total of 19 bleeding episodes from any source occurred in 15 patients in the shunt group compared with 100 episodes in 33 patients in the endoscopic group . There was no difference in survival with estimated 1-year survival rates for shunted and endoscopically treated patients of 90 % and 89 % , and 2-year survival rates of 79 % and 82 % , respectively . The incidence of clinical ly significant hepatic encephalopathy after 1 year was higher in the shunt group ( 36 % vs 18 % , p = 0.011 ) . INTERPRETATION These results suggest , that the transjugular shunt is more effective than endoscopic treatment in prevention of variceal rebleeding but has a considerable risk of hepatic encephalopathy . Survival is similar in the two groups Background : R and omised controlled trials ( RCTs ) have shown that endoscopic haemostasis is beneficial for patients with a bleeding peptic ulcer . The relevance of such data to management outside of RCTs is unclear . Therefore we examined management of patients with a bleeding peptic ulcer in a UK teaching hospital . Methods : All patients who underwent upper gastrointestinal ( UGI ) endoscopy for bleeding peptic ulcer between 1997 and 1999 were identified from an endoscopy data base and the clinical records review ed retrospectively . Results : A total of 872 patients underwent UGI endoscopy for presumed acute UGI haemorrhage ; 179 ( 21 % ) had an endoscopic diagnosis of bleeding peptic ulcer . Seventy nine patients had a peptic ulcer with stigmata of recent haemorrhage ( SRH ) but only 61 ( 77 % ) of these patients received endoscopic haemostasis ( 77 % adrenaline , 23 % combination therapy ) . Re-bleeding occurred in 24 patients with SRH in whom transfusion requirement was the sole predictor of re-bleeding . The re-bleeding rate among patients who received adrenaline was 25 % ( n=12 ) , compared with 57 % ( n=8 ) in the combination group and 31 % ( n=4 ) in those who did not receive endoscopic haemostasis . Patients who received combination endoscopic haemostasis had an increased incidence of active bleeding ( p=0.007 ) and an increased transfusion requirement ( p=0.002 ) . Eleven of 20 patients who re-bled had repeat endoscopic haemostasis , with 45 % eventually requiring surgery . Conclusions : Results of endoscopic management of bleeding peptic ulcers in the unit studied differ markedly from those published by specialised centres . The data reported here suggest that increased st and ardisation of endoscopic haemostasis is required , especially in units with provision for emergency “ out-of-hours ” endoscopy , performed by several individuals of different grade BACKGROUND In order to evaluate the prophylactic impact of sclerotherapy of small varices in patients with cirrhosis and no endoscopic signs suggesting risk of haemorrhage , a r and omized clinical trial was performed . METHODS Seventy-one hospitalized patients met the inclusion criteria of diagnosis of cirrhosis with no previous bleeding and small varices . Due to exclusion criteria of : gastroduodenal ulcers ( n = 5 ) , diverticulosis ( n = 1 ) , hepatic insufficiency ( n = 10 ) , hepatocellular carcinoma ( n = 4 ) , death before r and omization ( n = 6 ) , age over 70 ( n = 1 ) and denial of consent to participate in the study ( n = 1 ) , 43 patients could be r and omized , 21 for sclerotherapy and 22 for the control group . Two patients ( one in each group ) were lost to follow up , and another patient , although not lost , refused sclerotherapy after r and omization . Ethanolamine oleate was used as the sclerosing agent . All patients were followed up for a mean time of 60 months , initially every 2 months for the first 2 years and clinical and endoscopic controls were performed each 6 - 12 months thereafter . RESULTS AND CONCLUSIONS During the first 2 years clinical assessment showed that there were five bleedings in the sclerotherapy group and none in the control group , but mortality was similar in both groups . Long-term follow up continued to show a higher prevalence of bleeding in the sclerotherapy group but that mortality was not different from the control group OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials BACKGROUND AND STUDY AIM The aim was to evaluate the 30-day mortality after endoscopy for suspected upper gastrointestinal bleed , following the implementation of national audit guidelines at our hospital . PATIENTS AND METHODS All patients with suspected upper gastrointestinal bleeding , referred for endoscopy to our teaching hospital between October 2001 and December 2003 , were included in a prospect i ve cohort study . RESULTS A total of 716 patients with suspected upper gastrointestinal tract haemorrhage were referred for urgent endoscopy .  The median age was 69 years ( interquartile range 51 - 80 years ) .  Bleeding from peptic ulcer remained the single most common endoscopic diagnosis ( 40 % ) . The overall re-bleeding rate for all patients with a gastrointestinal haemorrhage was 10 % . The overall 30-day mortality rate was 14.6 % . This was not significantly different from the mortality rate in 1995 of 10.5 % ( P = 0.11 ) . Patients who died were significantly older ( 78 vs. 67 years , 95 % CI of the difference 5 to 12 , P < 0.001 ) . However , in only 29 % ( 30/105 ) was gastrointestinal haemorrhage stated in the death certificate as a factor which contributed to their death . CONCLUSIONS Our results show that implementing the good practice guideline has a limited impact on overall mortality because of contributing factors that are beyond the control of clinicians UNLABELLED Current therapy for preventing the first variceal bleed includes beta-blocker and variceal b and ligation ( VBL ) . VBL has lower bleeding rates , with no differences in survival , whereas beta-blocker therapy can be limited by side effects . Carvedilol , a non-cardioselective vasodilating beta-blocker , is more effective in reducing portal pressure than propranolol ; however , there have been no clinical studies assessing the efficacy of carvedilol in primary prophylaxis . The goal of this study was to compare carvedilol and VBL for the prevention of the first variceal bleed in a r and omized controlled multicenter trial . One hundred fifty-two cirrhotic patients from five different centers with grade II or larger esophageal varices were r and omized to either carvedilol 12.5 mg once daily or VBL performed every 2 weeks until eradication using a multib and er device . Seventy-seven patients were r and omized to  carvedilol and 75 to VBL . Baseline characteristics did not differ between the groups ( alcoholic liver disease , 73 % ; median Child-Pugh score , 8 ; median age , 54 years ; median follow-up , 20 months ) . On intention-to-treat analysis , carvedilol had lower rates of the first variceal bleed ( 10 % versus 
    Output:
    
Both interventions were associated with adverse events .
AUTHORS ' CONCLUSIONS This review found a beneficial effect of b and ing ligation on primary prevention of  upper gastrointestinal bleeding in patient with oesophageal varices .
The effect on bleeding did not reduce mortality .
Additional evidence is needed to determine whether our results reflect that non-selective beta-blockers have other beneficial effects than on bleeding