A64 PERFORMING ERCP AT A CANADIAN ACADEMIC INSTITIUATION: QUALITY PROCEDURES START WITH THE RIGHT INDICATION.
Bibliographic record
Abstract
Endoscopic Retrograde Cholangiopancreatography (ERCP) has diagnostic as well as therapeutic potential. However, given the availability of non-invasive diagnostic modalities, such as Magnetic Resonance Cholangiopancreatography (MRCP), the indications for performing ERCP have now shifted towards therapeutic procedures. In 2015, the American Society of Gastrointestinal Endoscopy (ASGE) published quality indicator guideline in ERCP. An appropriate procedural indication was considered a priority indicator and the task force selected a performance target of > 90%. There are no recent practice audits that review the indications for ERCP in Canada. Our primary outcome is to measure how often ERCP is performed in accordance with the ASGE guidelines for procedural indication. Secondary outcome measures include the diagnostic yield and adverse event rates when an ERCP is performed outside of the ASGE guidelines for clinical indication. An observational, retrospective review of all ERCPs in the central zone of the Nova Scotia Health Authority (NSHA) over a one year period between April 2015 and March 2016 was performed. New ERCP procedures were considered for inclusion in the review. 560 patients met the inclusion criteria during this time period. We accessed the patients electronic files through the Clinical Outcomes Research Initiative (CORI) data base. Basic demographic data was extracted. The procedural indications were recorded and compared with the ASGE clinical guidelines to access our compliance. The procedures that were not consistent with guidelines were analyzed further to determine a diagnostic yield and complication rate. Of the 560 procedures, 14 (2.5%) were performed for an indication inconsistent with the ASGE clinical guidelines. 6 patients (43%) met the clinical criteria for biliary Sphincter of Oddi dysfunction type III, and 4 cases (29%) were performed for biliary pancreatitis without evidence of biliary obstruction. Among the 14 ERCP procedures, common bile duct stones/sludge were actually found and removed in 5 cases (36%). There was no procedure related complications reported, however, one patient had transient oxygen desaturation during the procedure. The procedural indication for ERCP in our institution during this quality analysis appear to be consistent with the ASGE guidelines in about 97% of procedures, which is within the performance target recommended by the ASGE quality indicator guideline. In cases when ERCP was performed outside the recommended guidelines, MRCP is a reasonable option to identify the hepatobiliary pathology prior to ERCP. Although no serious adverse events were determined in this audit, larger numbers of patients over a longer period of time would be needed to conclude this. 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 | 0.004 | 0.025 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| 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".