A76 SINGLE OPERATOR PANCREATOSCOPY IN THE EVALUATION OF PANCREATIC NEOPLASMS: A CASE SERIES
Notice bibliographique
Résumé
Pancreatic neoplasms are most commonly diagnosed by endoscopic ultrasound (EUS), computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP). However, all these imaging modalities have limitations in their ability to diagnose small main duct intraductal papillary mucinous neoplasm (MD-IPMN) or early pancreatic neoplasms. Single operator pancreatoscopy (SOP) is a new modality to diagnose pancreatic neoplasia that is gaining popularity as case series and a retrospective single-center study have been published showing favorable efficacy. This case-series was performed to evaluate our centre’s experience with SOP. Patients who underwent SOP using the SpyGlass Direct Visualization System (Boston Scientific, Natick, Mass) between June 2013 and July 2016 were identified. Main outcome measurements included efficacy and safety of pancreatoscopy. During the study period, 32 patients underwent SOP for evaluation of suspected IPMN or pancreatic duct neoplasia. Prior to SOP, all patients had either an EUS or MRCP. Twenty-two (68.8%) patients had an EUS while 29 (90.6%) had MRCPs with indeterminate features for MD-IPMN or pancreatic neoplasia. Twenty-one (65.6%) patients were female and the mean age was 64.9 ± 12.2 years at the time of procedure. Technical failure occurred in 6 (18.8%) patients. Samplings through biopsy or brushing, were performed in 8 (30.7%) of patients. Overall, 13 (40.6%) patients had a pancreatic duct neoplasia, MD-IPMN, side branch IPMN or combined IPMN. In one patient, the pancreatoscope could not be introduced into the pancreatic duct. High-risk patients (n=8) were considered to be individuals who were diagnosed with MD-IPMN with or without side branch involvement. One patient is currently awaiting surgery. Five patients (71.4%) were diagnosed with adenocarcinoma and 1 (14.2%) was diagnosed with a dysplastic cyst via surgical specimens. The last patient did not undergo surgery and is being followed with serial imaging that has yet to suggest malignancy. Of the 19 patients with a negative pancreatoscopy for IPMN, 0 have developed an IPMN or pancreatic neoplasm in mean follow up of 1.5 years (SD 0.67). In our series, if pancreatic duct cannulation is successful, SOP has a diagnostic accuracy, sensitivity and specificity of 92.3%, 100% and 90.4% respectively for determining high risk IPMN/pancreatic cancers at time of ERCP. Complications occurred in 2 (7.6%) patients, 1 (3.8%) mild post-ERCP pancreatitis and 1 (3.8%) contained perforation related to sphincterotomy. Prophylactic pancreatic stents were placed in 27 (84.4%) patients and rectal indomethacin was used in 27 (84.4%) patients. Our case-series suggests that SOP to evaluate for pancreatic neoplasia is safe and adds important information in the evaluation of pancreatic duct neoplasm that are not definitively diagnosed by EUS or MRCP. 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) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».