A183 PERFORMANCE CHARACTERISTICS OF LUMEN-APPOSING METAL STENT FOR EUS-GUIDED TRANS-LUMINAL DRAINAGE OF PANCREATIC FLUID COLLECTIONS
Bibliographic record
Abstract
Pancreatic fluid collections (PFCs) can develop as a complication in 6–20% of acute pancreatitis cases. According to the revised Atlanta Classification, PFCs warranting endoscopic drainage are categorized as either a pancreatic pseudocyst (PP) or walled-off necrosis (WON). Endoscopic-ultrasound (EUS)-guided drainage of PFCs has become the preferred modality of initial intervention but there remains debate as to the optimal type of stent. A recent trend towards the use of lumen-apposing metal stents (LAMS) has emerged. To evaluate the performance characteristics of a LAMS in the EUS-guided endoscopic management of PFCs based on our institutional protocol (CT scan 1 week after placement to assess for resolution and need for necrosectomy followed by stent removal within in 3 weeks of placement). A prospective registry of all patients that underwent PFC drainage with a LAMS. The primary outcome was stent functionality (absence of stent-related re-intervention during period of stent indwell). Secondary outcomes were clinical success (sustained resolution at 3 months after LAMS removal), technical success, procedure time, total number of endoscopic procedures with or without necrosectomy, stent indwell time and adverse events (buried stent, migration, bleeding, perforation and 30-day mortality). Twenty-seven patients (16 males, with median age 47 years [range 9–85]) underwent placement of LAMS for 29 PFCs (median size 11 cm [range 6–22 cm]). There were 13/29 (45%) PP and 16/29 (55%) WON. Technical success and stent functionality was 100%, respectively. The median procedure time was 13 min (IQR 11.8–20.3 min). A total of 6/29 (21%) PFCs (1 PP, 5 WON) required repeat endoscopy during stent indwell. No intervention was undertaken in the 1 pp. In the 5 WONs, 4 underwent necrosectomy (3 necrosectomy sessions in 1, 2 sessions in 1 and 1 session in 2) and 1 required no intervention. The median stent indwell time was 20 days (IQR 13–28 days). Clinical success was seen in 24/29 (83%) PFCs. The remaining 5 patients had successful resolution of their PFC but 3 underwent surgery (1 had unrelenting abdominal sepsis, 1 had PFC extending into both para-colic gutters and 1 had the gastro-duodenal artery traversing the PFC contraindicating necrosectomy) and 2 patients died from underlying malignant disease. There were no adverse events although 2 patients died within 30 days not related to the LAMS (discussed above). Our institutional protocol of PFC demonstrated excellent performance characteristics of LAMS. LAMS may be the preferred modality for endoscopic management of PFCs. 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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".