A52 ENDOSCOPIC CLOSURE OF PERFORATED PEPTIC ULCER IN A PATIENT WHO WAS A CHALLENGING CANDIDATE FOR SURGICAL MANAGEMENT
Bibliographic record
Abstract
The incidence of peptic ulcer disease (PUD) in developed countries has overall decreased but is still seen commonly in patients above the age of 60. The commonest complication of PUD is hemorrhage (73%) followed by perforation (9%) and obstruction (3%). Perforated peptic ulcer (PPU) is associated with a mortality of at least 25%. Traditionally, PPU is managed surgically, however the postoperative course is also associated with a high risk of complications and mortaliy. To describe the first case report of endoscopic loop and clips closure technique used for perforated gastric ulcer, augmented by video. We describe a case of a 68 year old patient with complicated past medical and surgical history who presented 9 days post small bowel resection for a partial small bowel obstruction with an acute abdomen. CT scan demonstrated a large collection in the left upper quadrant and free air, confirming perforation. He was brought to the Operating theatre emergently for an exploratory laparotomy due to his unstable status. As he had a “frozen abdomen” from severe adhesions from previous surgeries, the surgery team was unable to repair the perforation. The left upper quadrant was irrigated and a sump drain inserted. Repeat CT scan post op showed features consistent with persistent perforation. The Gastroenterology team was consulted for endoscopic closure of the perforations. Two perforated gastric ulcers were successfully repaired with the loop and clips technique. Repeat endoscopy after showed complete healing of the defects. This case presentation is augmented by video. This is the first report of the endoscopic loop and clips closure technique used for a perforated gastric ulcer, with successful outcomes. PPU is associated with a high rate of mortality and morbidity and traditionally is managed emergently by surgery. Post operative mortality for PPU is estimated to be 6–10%, and is 3 to 5 times higher in the elderly population. Endo et al first described the loop and clips technique in 2004. In the literature, multiple other techniques are described for endoscopic closure of defects PUD is commonly seen in the elderly population, PPU is a rare but dangerous complication. In our patient, who was a challenging candidate for surgical management, endoscopic repair of PPU with the loop and clips technique was successful. In select patients perhaps endoscopic repair of PPU with the loop and clips technique may be a simple and feasible alternative to operative management and its associated high risk of complications, costs of prolonged hospital stay and mortality. 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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".