Safety of Yttrium-90 Radioembolization for Patients with History of Biliary Intervention: Final Results of a Multicenter Study
Bibliographic record
Abstract
Objective: To determine prevalence of hepatobiliary infections following Yttrium-90 ( 90 Y) radioembolization in patients with history of biliary instrumentation. Materials and Methods: Records of 126 patients (median: 64 years, 84 men) with primary ( n = 40) or metastatic ( n = 86) cancer of the liver and a history of biliary-enteric anastomosis ( n = 65), sphincterotomy ( n = 17), or indwelling biliary stent ( n = 36) or drain ( n = 5) across the ampulla of Vater, who underwent 180 90 Y radioembolization procedures with resin or glass microspheres at 14 high-volume centers between 2005 and 2016 were retrospectively reviewed. The primary outcome was development of hepatobiliary infection. Univariate and multivariate analyses were performed using generalized estimating equation method. Results: Hepatobiliary infections (abscesses in 8 patients, cholangitis in 4 patients) developed following 12 (6.7%) radioembolization procedures in 11 (8.7%) patients. Ten patients required at least one hospitalization (range: 1–7), spent a median of 12 days (range 2–113) in a hospital for treatment of the infection, and required invasive treatments including percutaneous abscess drainage ( n = 10), endoscopic retrograde cholangiography with stenting and removal of stones ( n = 3), or insertion of percutaneous biliary drains ( n = 1). Infections resolved in six patients, two patients died secondary to infection, and three patients continue to receive antibiotics. Glass microspheres ( p = 0.02), prior liver resection ( p = 0.019), and younger age ( p = 0.003), were independently predictive of a higher risk of infection based on multivariate models. Antibiotic prophylaxis and bowel preparation were not protective against infection. Conclusion: Hepatobiliary infections are uncommon but morbid and difficult to manage complications of 90 Y radioembolization in patients with a history of biliary instrumentation.
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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 | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".