A327 THE IMPACT OF ENDOSCOPIST CASE VOLUMES RELATED TO ERCP
Notice bibliographique
Résumé
Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure used to diagnose and treat a variety of hepatobiliary and pancreatic conditions. ERCP has transitioned from a diagnostic test to a therapeutic intervention, with the complexity of cases becoming more challenging and the possibility of subsequent complications increasing. Previous studies have demonstrated that high volume endoscopists (HVE; >75 ERCP /year) have greater success compared to low volume endoscopists (LVE), despite performing more complex procedures. After our previous study demonstrated the benefit of having ERCP performed by HVE, our site transitioned to all procedures performed by HVE. The aim of our study was to determine if this strategy resulted in improved ERCP outcomes at our centre. A retrospective chart review of all ERCPs completed between September 2014 - September 2016, collecting data on cannulation success rate, ERCP complexity score, and any significant post-ERCP complications. These results were compared to ERCP patient outcomes performed between January 2010 - December 2012 which were completed by mixed volume endoscopists (MVE). From January 2010 - December 2012, six MVE performed a total of 1246 ERCP while only four HVE performed a total of 1385 ERCP from September 2014 to September 2016. Patient demographics were similar between both groups. Successful cannulation was achieved in 92.5% for the HVE group, in comparison to 89.8% for the MVE group (OR 1.40, 95% CI 1.07–1.84, P=0.02), while the overall success rate was 89.2% in the HVE group versus 86.7% for the MVE group (OR 1.27, 95% CI 1.00–1.60, P=0.05). Once adjusted for ERCP complexity, the OR for successful cannulation was 1.32 (95% CI 1.04–1.68, P=0.03), and for successful completion of the procedure was 1.32 (95% CI 1.00–1.74, P=0.05). The rate of unintentional cannulation of the pancreatic duct (PD) was not different between the HVE and MVE groups (18.7% and 17.2%, respectively; OR 1.11, 0.91–1.35, P=0.3); however, the PD injection was lower in the HVE compared to the MVE group (5.4% vs. 9.8, P<0.001). The risk of post-ERCP pancreatitis rates was not different for the HVE and MVE groups after adjustment for complexity score (3.4% vs. 2.9%, OR 1.08, 95% CI 0.80–1.49, P=0.6). The risk of perforation was lower in the group of HVE compared to MVE, after adjusting for complexity score (0.2% vs. 0.6%, OR 0.25, 0.06–0.96, P=0.04). There was no mortality in either group. The outcomes of patients undergoing ERCP at our centre has significantly improved with limiting ERCP to be performed by select HVE. While this data only reflects the experience at a single centre, transitioning complex care of ERCP patients to expert facilities performing HVE may result in improved patients outcomes. 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 | 0,005 | 0,068 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 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 ».