A Retrospective Comparison of ERCP Complications with Conventional ERCP vs. Wire Guided ERCP
Bibliographic record
Abstract
Purpose: Endoscopic Retrograde Cholangiopancreatography (ERCP) is an invasive endoscopic technique which affords both diagnostic studies and therapeutic interventions. This procedure is associated with potentially severe complications including post ERCP pancreatitis. A factor that may increase the risk of post ERCP pancreatitis is contrast opacification of the pancreatic duct. Recently, a wire guided technique has been developed which avoids opacification of the pancreatic duct. The purpose of this study was to determine whether there was any difference in post ERCP pancreatitis requiring hospitalization when conventional cannulation using contrast is compared with wire guided cannulation. Methods: A retrospective review of ERCP at a single institution was performed. In 2005 there was a change made from a conventional contrast injection approach to use of a wire guided approach to ERCP. This latter technique involves cannulating the common bile duct with a guide wire prior to injecting contrast. If the pancreatic duct is cannulated, no contrast is injected. A retrospective chart review of ERCPs performed in April through September 2004 and January through June 2005 was performed. Data on procedure length, indication, and complications including pancreatitis was gathered. Pancreatitis was defined as pain post procedure associated with an increased lipase and requiring a hospital stay. Results: A total of 282 ERCPs were performed within the study period by 3 endoscopists, with 14 episodes of post-ERCP pancreatitis (5.0%) documented. The mean age of the patients was 63 years with 42% being male. The major indications for ERCP were biliary colic or obstructive jaundice (75%) and therapeutic intervention was performed in 77% of cases. There were no differences in demographics between groups. In the 2005 period, 130 ERCPs were performed, with 3 cases of pancreatitis, compared with 152 ERCPs in 2004, with 11 cases of pancreatitis [Odds Ratio 0.30 (0.08 to 1.11)]. During the study period, 167 ERCPs were performed using the wire guided technique, with 4 cases of pancreatitis, compared with 115 ERCPs performed conventionally, with 10 cases of pancreatitis [Odds Ratio 0.26 (0.09 to 0.79)]. Procedure length was a mean of 32 min and 35 min for conventional and wire guided ERCP respectively. (P= 0.08). Conclusion: This retrospective study demonstrates that wire guided ERCP is associated with a lower rate of post-ERCP pancreatitis than conventional ERCP.
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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 | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| 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".