Predictors of Outcome of Endoscopic Therapy in the Management of Patients With Pancreas Divisum: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Predictors of response to endoscopic therapy in patients with pancreas divisum are not well established. We sought to identify predictors of successful endoscopic therapy by performing a meta-analysis of the studies that assessed variables associated with improved outcomes. Methods: Electronic database search was performed. Only full text English language studies were included. Random effect model was used to pool the effect size across studies. Studies quality was assessed using the checklist developed by the Institute of Health Economics (Alberta, Canada) to assess the quality of case series. Because multiple not well established outcomes were reported, the most objective outcome measured was used in the analysis. Data were pooled on a specific variable if two or more studies reported outcome associated with the variable. Predictors were broadly categorized into patient related and endoscopic technique related. Results: Twenty studies (out of 370 articles reviewed) with 831 patients met the inclusion criteria. 90% of studies were case series and utilized a wide spectrum of endoscopic therapies / combination of therapies that fell into one of three categories: minor papilla sphincterotomy, dorsal duct stenting and minor papilla endoscopic sphincteroplasty. Indications for Endoscopic therapy were acute recurrent pancreatitis, chronic pancreatitis and chronic abdominal pain. The efficacy rate of achieving “improvement” after endoscopic therapy varied significantly across studies and ranged from 16% to 94% with a pooled rate of 58.4% (95% CI: 48.5-67.6; p=0.096). Among patient-related predictors, recurrent acute pancreatitis was associated with better endoscopic outcome compared to chronic pancreatitis or chronic abdominal pain (RR 3.07; 95% CI: 2.31-4.08). There was marginal benefit among male patients (RR 1.19; 95% CI: 0.97-1.56) and patients with complete divisum compared to incomplete divisum (RR 1.25; 95% CI: 0.99-1.58). Among endoscopic technique related variables, 2 or more endoscopic therapy sessions was the only variable associated with improved outcome (RR 1.29; 95% CI: 1.02-1.91). Conclusion: While high quality studies in support of endoscopic therapy in the management of PDiv are lacking, the currently available evidence suggests better outcomes associated with multiple / repeated sessions of endoscopic therapy and when performed for patients with recurrent acute pancreatitis. Male gender and complete divisum may be associated with marginal benefit as well.
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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 | 0.016 | 0.035 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.040 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 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 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".