S1130 Safety and Efficacy of Endoscopic Ultrasound-Guided Gallbladder Drainage Performed by Early Career Advanced Endoscopists: A Multicenter Experience
Notice bibliographique
Résumé
Introduction: Endoscopic ultrasound-guided gallbladder drainage (EGBD) using lumen-apposing metal stents (LAMS) has increasingly become an option for patients with acute cholecystitis or symptomatic cholelithiasis who are not surgical candidates. Recent studies have shown EGBD to be safe and effective. However, these data come from experienced advanced endoscopists. There is currently no data regarding the safety and effectiveness of EGBD in the hands of early career advanced endoscopists. We aimed to evaluate the safety and effectiveness of EGBD performed by early career advanced endoscopists. Methods: This was a multicenter, retrospective analysis of all patients who underwent EGBD, performed by 7 early career advanced endoscopists. Early career advanced endoscopist was defined as within two years of graduating advanced endoscopy fellowship. Patient and procedural characteristics were recorded. Primary outcomes were technical and clinical success. Technical success was defined as the ability to place the stent within the gallbladder. Clinical success was defined as improvement or resolution of gallbladder related symptoms within 5 days of the procedure. Other outcomes included adverse events and procedure related mortality. Results: A total of 21 patients underwent EGBD. All advanced endoscopists were within 18 months of completion of an American Society for Gastrointestinal Endoscopy (ASGE) accredited advanced endoscopy fellowship. The indication was acute cholecystitis in 18 cases (86%) and symptomatic cholelithiasis in 3 cases (14%). 48% were female, 81% were inpatients and the mean age was 75 years. The mean platelets and INR were 247 K/cmm and was 1.2, respectively. Eight patients were on anticoagulation. The EGBD was performed with the transgastric approach in 15 cases (71%) and transduodenal approach in 6 cases (29%). Clinical and technical success were achieved in all cases. One patient developed post-procedural pain within 30 days and one patient required overnight admission overnight. No patients developed recurrent cholecystitis, bleeding, perforation, stent migration or death within 30 days. Ten patients (48%) had the LAMS removed and the average time to LAMS removal was 41 days. The median duration of follow-up was 75 days. (Table) Conclusion: Our findings suggest that endoscopic ultrasound-guided gallbladder drainage is safe and effective in the hands of formally trained early career advanced endoscopists. Table 1. - Patient and Procedural Characteristics Indication N = 21 patients Acute Cholecystitis 18 (86%) Symptomatic Cholelithiasis 3 (14%) Patient characteristics Female 10 (48%) Age 75 years (SD 12) Inpatient 17 (81%) Chronic kidney disease 3 (14%) Diabetes mellitus 11 (52%) Cirrhosis 1 (5%) Platelet count (K/cmm) 247 (SD 64) INR 1.2 (SD 0.22) Anticoagulation use Apixaban Enoxaparin 8 (38%)7 (33%)1 (5%) Procedure characteristics Site of Lumen Apposing Metal Stent placement Stomach Duodenum 15 (71%)6 (29%) Size of Lumen Apposing Metal Stent 10 mm x 10 mm 15 mm x 10 mm 14 (67%)7 (33%) Outcomes Technical success 21 (100%) Clinical success 21 (100%) Stent removed 10 (48%; average 41 days) Recurrent Cholecystitis 0 Length of follow-up (days, median) 75 Adverse events Any adverse event 2 (10%) Need for admission following procedure 1 (5%) Post-procedural pain within 30-days 1 (5%) Death within 30-days 0
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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 | 0,004 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
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 ».