The significance of gallbladder sludge in the patient with acute pancreatitis
Bibliographic record
Abstract
The significance of gallbladder sludge as a potential cause of acute biliary pancreatitis is debated. We report the incidence and outcome of patients with gallbladder sludge in a large population of patients with pancreatitis. Pancreatitis was defined as constant epigastric pain with lipase greater than three times the upper reference value for our laboratory (177 U/l). Consecutive patients with first episodes of acute pancreatitis were identified over a 2-year period and data were evaluated retrospectively. Patients were followed prospectively for 2 years more. All patients had gallbladder ultrasound examinations. First episodes of acute pancreatitis were identified in 356 patients. Initially 236 patients had stones directly visualized in the gallbladder. Of the remaining 120 patients, 13 had sludge, 11 had a dilated common bile duct, one had a positive sonographic Murphy sign, and 95 had no abnormalities. During the time course of the study, 23 of these 120 patients were demonstrated to have stones; by the surgical pathology report (12), endoscopic retrograde cholangio-pancreatography (10), and cholecystostomy (one). Seven of 13 patients with sludge underwent cholestectomy and all had evidence of stones. Four of six nonoperated patients with sludge (67%) returned with recurrent pancreatitis over the course of the study. Ten of 97 patients (10%) with suspected nonbiliary etiology of the pancreatitis returned with recurrent pancreatitis over the same period. The nonoperated patients with sludge were more likely to have other risk factors for nonbiliary pancreatitis than were the operated patients. The presence of sludge on the gallbladder ultrasound suggests the presence of stones and is associated with a high rate of recurrence of pancreatitis in nonoperated patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".