A221 OPTIMAL PROCEDURAL SEQUENCE FOR SAME-DAY BIDIRECTIONAL ENDOSCOPY WITH SEDATION: A SYSTEMATIC REVIEW AND META-ANALYSIS STUDY OF CONTROLLED TRIALS
Bibliographic record
Abstract
Same-day bidirectional endoscopy (BDE) is a commonly performed procedure, but the optimal sequence for the procedure is not well established. This study aimed to assess if upper endoscopy before colonoscopy was better than the opposite sequence. Main outcome measures were time of procedure, sedation used, recovery time, and quality of procedure. To conduct a systematic review and meta-analysis of controlled trials of moderate sedation that compared the sequence of combination procedures. Search strategy up to 2018 was conducted and relevant papers retrieved for analysis. All data was extracted as per-protocol by 2 reviewers in a double-blind fashion and discrepancies resolved by a third person adjudicator. Data were pooled where possible to get a summary effect. Seven studies (N=1974 patients) were included. There were 6 randomized controlled trials, and 1 prospective cohort study with tandem procedures. None of the studies were from North America. Time of procedure was similar for upper endoscopy and colonoscopy regardless of which was done first, and there was no difference in the total time (Mean difference -0.04 minutes [-0.64, 0.56 p=0.89]). Three studies (N=455) reported recovery time was significantly better in the endoscopy first group (Mean difference -4.42 minutes [-5.26,-3.58]). Sedation data could not be statistically combined due to heterogeneity, but a clear trend suggested higher sedation was used in the colonoscopy first group. Limitations: marked variability in designs, protocols for sedation, and poor methodologic quality of most studies. Bidirectional endoscopy is a common procedure in gastroenterology, and the optimal sequence remains controversial. Starting with upper endoscopy does not reduce procedure times, but may reduce the amount of sedation and consequently, the recovery time. These findings may represent a subtle, but meaningful difference for patients and endoscopy units to consider. 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 | 0.017 | 0.050 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.039 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| 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".