The use of the paediatric gastroscope to deploy self-expanding metal stents in patients with cancer of the oesophagus at Dr. George Mukhari Academic Hospital
Bibliographic record
Abstract
Background: Oesophageal carcinoma continues to be a major cause of cancer related deaths worldwide. Metal stents are an established treatment option for palliation of dysphagia. These stents are classically deployed using endoscopy with fluoroscopic control. An alternative technique is using the paediatric endoscope.Methods: The study is a retrospective review of all cases of esophageal stenting at Dr George Mukhari Academic Hospital, Pretoria, South Africa were included. A prospectively maintained database Olympus Endobase® is used in the endoscopy suite. All cases between March 2015- February 2018, where the oesophagus was stented were reviewed. Cases where the paediatric scope was used were analysed further. Data captured from the database included demographics, tumour length, the presence of trahceoesophageal fistula.Results: A total of 233 patients were stented, the paediatric scope was used in 217. The procedure was successfully completed in 84,7% of the patients. Repeat stenting was required in 20 patients. The mean age was 57 years (32-97). Average length of the stricture 9,6cm (5-15cm). The reasons for palliation were patient unfit for surgery (n=159), associated TOF (n=15), unspecified (n=38). The reasons for repeat stenting were stent migration (n=5), tumour overgrowth (n=10) and blocked stent (n=5). Complications were recorded in 1 case where an iatrogenic perforation was caused which was successfully stented. In the 33 cases that failed the reason for failure was inability of the scope to negotiate the stricture. These cases were subsequently completed successfully using a guidewire with fluoroscopy. There was no periprocedural mortality.Conclusions: It is safe and feasible to use the paediatric endoscope to stent tumours of the oesophagus. If the procedure is successful it prevents the exposure of the staff and the patient to radiation. It ensures reliable placement of the guidewire into the stomach as well as confirming appropriate positioning of the stent.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".