The Efficacy of Endoscopic Therapy in the Management of Patients With Pancreas Divisum: A Meta-analysis
Bibliographic record
Abstract
Introduction: pancreas divisum (PDiv) has been implicated in the development of acute and chronic pancreatitis. Endoscopic therapy has been reported to improve some objective and subjective outcomes. We sought to perform a meta-analysis of the studies that assessed the efficacy of endoscopic therapy in the management of PDiv. Methods: Electronic database search was performed for relevant studies. 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 validated and ascertained outcomes were reported, the most objective dichotomous outcome measured was used in the analysis. Heterogeneity testing and publication bias assessment were also performed. Results: Twenty studies (out of 370 articles reviewed) with 831 patients met the inclusion criteria. The majority of studies (90%) were case series and utilized a wide spectrum of endoscopic therapies/combination of therapies that fell broadly into one of three categories: minor papilla sphincterotomy, dorsal duct stenting and minor papilla endoscopic sphincteroplasty. The mean follow up duration across studies was 21 months (4-67). Indications for Endoscopic therapy were acute recurrent pancreatitis, chronic pancreatitis and chronic abdominal pain of suspected pancreatic origin. The efficacy rate of achieving “improvement” after endoscopic therapy varied significantly across studies and ranged from 16% to 94%. 437/831 patients were reported to have improved with endoscopic therapy (mostly multiple sessions) corresponding to a pooled efficacy rate of 58.4% (95% CI: 48.5-67.6; p=0.096). Significant heterogeneity was observed within and across studies (Q=119; I2=85%).Figure 1Conclusion: high quality studies in support of endoscopic therapy in the management of PDiv are lacking. Available studies are mainly case series and of low quality. Based on currently available evidence, the estimated efficacy of endoscopic therapy is 58% but this estimate is neither robust nor precision due to poor quality of available studies and significant heterogeneity.
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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 | 0.019 | 0.031 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.067 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".