A PROSPECTIVE, RANDOMIZED, MULTICENTER STUDY COMPARING SEMS PLACEMENT WITH AND WITHOUT BILIARY SPHINCTERECTOMY IN PATIENTS WITH MALIGNANT BILIARY OBSTRUCTION: AN INTERIM ANALYSIS
Bibliographic record
Abstract
Aims: Aim of the study was to investigate the outcomes of patients with malignant biliary obstruction undergoing self-expandable metallic stent (SEMS) placement with and without endoscopic sphincterotomy (ES). NCT number 03628001. Methods: This is an interim analysis of an ongoing multicenter randomized prospective study conducted in four international tertiary referral centers from March 2016 to October 2018 in patients with malignant distal biliary obstruction with indication to SEMS placement. Patients were randomized to ES prior to fully covered (FC) SEMS placement (ES, G1) versus FCSEMS placement leaving the papilla without (No ES, G2). The primary outcomes were immediate (periprocedural) and delayed (< 30 days) post-ERCP adverse events (AE) including PEP, SEMS migration, bleeding and perforation (defined according to the ASGE lexicon). Results: 152 patients (82 (54%) female) of mean age 69.7 (range 43 – 93 years) with distal malignant biliary obstruction were included in the study. FCSEMS were successfully deployed in all patients in both groups. 76 patients (G1) were randomized to perform ES before placement of SEMS, and 76 patients to no ES (G2). Overall, complications occurred in 24 (31.5%) patients in G1 and in 17 (22.3%) in G2 (p = 0.2008). Although not statistically significant there was a trend toward increased risk of PEP in the G2 compared to the G1 (15.8% vs. 11.8%, p = 0.4807). Fatal AEs occurred in 1 patient because of cholangitis in G1 and in 1 patient because of post ERCP pancreatitis in G2. Conclusions: At interim analysis, placement of biliary FCSEMS without prior ES in patients with distal common bile duct obstruction showed a lower rate of cumulative AEs. On the other hand patients in G2 reported an higher incidence of PEP (although not statiscally significant). We aim to complete enrollement to the target sample size before making final conclusions.
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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 | 0.004 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".