A216 PREDICTING DIFFICULT CASES IN POEM (PER-ORAL ENDOSCOPIC MYOTOMY) PROCEDURES.
Notice bibliographique
Résumé
POEM (per-oral endoscopic myotomy) is emerging as the new endoscopic standard for treating patients with achalasia. Originating from Japan, POEM is now performed at many tertiary care centers in North America. Hitherto, data from institutions regarding the safety & efficacy of the procedure has shown promising results. To ensure that the procedure is seamless, identifying challenging cases ahead of time would allow for better resource allocation & to plan accordingly. To identify if certain pre-procedural factors are associated with intra-procedural factors or post-procedural complications, to ultimately formulate a POEM difficulty score to allow endoscopists to predict difficult cases ahead of time. 51 POEM procedures performed for achalasia at a tertiary care centre in Japan were analyzed in the study. Most procedures were performed by advanced-therapeutics trainees with close proctoring by experienced endoscopists. Various pre-determined pre-procedural factors (age, sex, achalasia type, duration of symptoms, Eckardt score, morphology & prior treatments); intra-procedural factors (tunnel distention, submucosal fibrosis, abnormal contractions, submucosal oozing, orientation, length of myotomy, procedure time, number of clips used & intra-procedural adverse events) & post-procedural data points were collected & analyzed. A preliminary POEM difficulty score (out of 10) was formulated with each component worth 2 points (tunnel distention, submucosal fibrosis, abnormal contractions, submucosal oozing, orientation). Analyses were performed using chi-square tests for categorical data & T-tests/ANOVAs/Spearmans correlations for continuous data. The mean age was 44.3 ± 15.5 yrs & mean duration of symptoms 8.1 ± 9.9 yrs. Mean Eckardt score was 6.7 ± 2.2. Six patients (11.8%) had an intra-procedural event & 3 (5.9%) had an in-hospital adverse event. In the univariate analyses, the POEM difficulty score did not correlate with the occurrence of an intra-procedural event (p=0.203) or post procedure complications (p=0.80). Factors that correlated with the POEM difficulty score included morphology (S1/S2 vs. NS-D or NS-ND, p=0.006), prior treatments (pneumatic dilation vs. none, p=0.028) & age (p=0.030). A multivariate regression analysis was also conducted with variables removed sequentially, and even though trends were seen with some variables, type of achalasia was the only variable that maintained significance (p=0.048). Based on this study, there are indications that procedures involving older patients; S1/S2 morphology; type of achalasia (Type 1); and those with prior treatments may be more difficult overall. Further validation of these results as well as the POEM difficulty score is needed as our study was limited by smaller numbers, minimal adverse events, more trainee involvement, and less challenging procedures overall. None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».