A167 EVALUATING THE DIAGNOSTIC YIELD OF COMPUTED TOMOGRAPHIC ENTEROGRAPHY FOR PATIENTS WITH IRON DEFICIENCY ANEMIA
Bibliographic record
Abstract
Although several etiologies exist, gastrointestinal bleeding is widely considered to be responsible for Iron Deficiency Anemia (IDA). Currently, there is debate regarding the most appropriate course of investigation following negative bidirectional endoscopy. Computed Tomographic Enterography (CTE) has emerged as a prospective diagnostic tool but limited studies have outlined its role, specifically for investigation of IDA. To evaluate the efficacy of CTE through diagnostic yield for patients with IDA. Furthermore, to outline etiologies of gastrointestinal bleeding, predictive symptoms, and changes in management for true positive cases. Patients were identified by CTE requisition orders at the Royal Columbian Hospital Centre consecutively between Jan 1, 2013 and June 1, 2017. Only patients diagnosed with Iron Deficiency Anemia, or who had experienced obscure occult gastrointestinal bleeding were included. To determine the diagnostic yield of CTE, patients’ charts were retrospectively studied. Negative endoscopy or lack of further small bowel investigation following a negative CTE was defined as a True Negative. Positive endoscopy for small bowel carcinomas matching the description of a prior CTE was defined as a True Positive. 937 CTE results were reviewed and 223 patients matched our inclusion criteria. 7 positive CTE results were identified, 3 of which were false positives. 216 negative CTE results were identified, none of which were false negatives. Follow-up Capsule Endoscopy (CE) was used in 13 negative cases, of which 3 identified non-malignant sources of GI bleeding. The diagnostic yield of CTE was 1.8%, with 100% sensitivity and 98.6% specificity. The etiologies of the 4 positive cases included a GIST tumor, a small bowel spindle cell neoplasm, and two moderately differentiated adenocarcinomas. Further investigation included an imaging technique (Colonoscopy or Laparoscopy) followed by surgical small bowel resection. In one case, CE was used to localize the tumor within the small bowel following positive CTE. None of the symptoms exhibited by the patients of the four positive cases were atypical of diagnostic symptoms of IDA. CTE has high sensitivity and specificity in investigating IDA. Only 1.8% of patients had a change in management based on CTE but all were significant. The four lesions identified by CTE required further imaging, including CE, before surgical resection. Given that CE has a higher diagnostic yield than CTE, it may be a better choice for IDA if no contraindication to CE exists, as opposed to CTE followed by CE. None
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| 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".