A327 THE IMPACT OF ENDOSCOPIST CASE VOLUMES RELATED TO ERCP
Bibliographic record
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure used to diagnose and treat a variety of hepatobiliary and pancreatic conditions. ERCP has transitioned from a diagnostic test to a therapeutic intervention, with the complexity of cases becoming more challenging and the possibility of subsequent complications increasing. Previous studies have demonstrated that high volume endoscopists (HVE; >75 ERCP /year) have greater success compared to low volume endoscopists (LVE), despite performing more complex procedures. After our previous study demonstrated the benefit of having ERCP performed by HVE, our site transitioned to all procedures performed by HVE. The aim of our study was to determine if this strategy resulted in improved ERCP outcomes at our centre. A retrospective chart review of all ERCPs completed between September 2014 - September 2016, collecting data on cannulation success rate, ERCP complexity score, and any significant post-ERCP complications. These results were compared to ERCP patient outcomes performed between January 2010 - December 2012 which were completed by mixed volume endoscopists (MVE). From January 2010 - December 2012, six MVE performed a total of 1246 ERCP while only four HVE performed a total of 1385 ERCP from September 2014 to September 2016. Patient demographics were similar between both groups. Successful cannulation was achieved in 92.5% for the HVE group, in comparison to 89.8% for the MVE group (OR 1.40, 95% CI 1.07–1.84, P=0.02), while the overall success rate was 89.2% in the HVE group versus 86.7% for the MVE group (OR 1.27, 95% CI 1.00–1.60, P=0.05). Once adjusted for ERCP complexity, the OR for successful cannulation was 1.32 (95% CI 1.04–1.68, P=0.03), and for successful completion of the procedure was 1.32 (95% CI 1.00–1.74, P=0.05). The rate of unintentional cannulation of the pancreatic duct (PD) was not different between the HVE and MVE groups (18.7% and 17.2%, respectively; OR 1.11, 0.91–1.35, P=0.3); however, the PD injection was lower in the HVE compared to the MVE group (5.4% vs. 9.8, P<0.001). The risk of post-ERCP pancreatitis rates was not different for the HVE and MVE groups after adjustment for complexity score (3.4% vs. 2.9%, OR 1.08, 95% CI 0.80–1.49, P=0.6). The risk of perforation was lower in the group of HVE compared to MVE, after adjusting for complexity score (0.2% vs. 0.6%, OR 0.25, 0.06–0.96, P=0.04). There was no mortality in either group. The outcomes of patients undergoing ERCP at our centre has significantly improved with limiting ERCP to be performed by select HVE. While this data only reflects the experience at a single centre, transitioning complex care of ERCP patients to expert facilities performing HVE may result in improved patients outcomes. None
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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 | 0.005 | 0.068 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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".