A336 AN UNUSUAL FINDING AT ERCP
Bibliographic record
Abstract
We present a rare complication during ERCP of portal vein cannulation emphasizing the importance of recognition of this to avoid potentially ominous complications. Our case will be presented below with a review of the literature A 56-year-old male known for dyslipidemia presented to a community hospital with a 3-week history of new postprandial epigastric pain and a 15 pound weight loss. An EGD demonstrated a duodenal mass partially obstructing D1. Biopsies of the mass revealed poorly differentiated adenocarcinoma. A CT abdomen showed eccentric thickening of the gastric antrum with aneurysmal dilation and abnormal appearance of D1 and D2. Abnormal tissue was described at the head of pancreas making it difficult to identify the origin of the mass. MRCP showed eccentric D1 and D2 thickening highly suggestive of a primary duodenal neoplasm (7.3x5.0x4.6cm). The mass did not appear to arise from the pancreas. Two additional masses, thought to be possible metastatic lymphadenopathy were described. The patient was transferred to a tertiary care center. While admitted there an elevated cholestatic liver enzyme pattern was noted to be worsened with no signs or symptoms of cholangitis. ERCP was arranged for suspected biliary obstruction prior to planned chemotherapy. During the ERCP the duodenal mass was easily traversed. The papilla had a normal appearance. Cannulation with sphincterotome and guidewire was performed. Contrast was injected however the biliary tree did not appear to opacify. Despite injecting significant amounts of contrast, it appeared as if the contrast was dispersing rapidly. Multiple fluoroscopic images were taken while adjusting the views as this was very atypical. It became apparent that the portal vein had been cannulated and the contrast was flowing through the portal vein. The procedure was aborted. No immediate complication occurred as a consequence of the PV cannulation during the ERCP. A percutaneous biliary drain was inserted the same day. Portal vein cannulation or opacification of the portal venous system during ERCP is an exceedingly rare complication with a reported incidence of less than 1/6000 [1]. The majority of cases reported in the literature have been in the context of pancreatic cancer and after sphincterotomy [2–5]. One portobiliary fistula was described pre-procedure [6]. Two cases have been reported in non-pancreatic cancer cases with standard wire guided cannulation technique [7, 8]. Although many complications including bleeding, sepsis and portal thrombosis are possible none of the reported cases have described any complications. Similarly, in our case no immediate post procedure complication arose. However, had stenting been undertaken the consequences would likely have been more detrimental. This exceptionally infrequent complication is therefore important to recognize promptly during ERCP, which should then be terminated immediately. NoneNone
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.007 | 0.004 |
| Insufficient payload (model declined to judge) | 0.007 | 0.006 |
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".