Unsedated Peroral Thin Scope Endoscopy for Screening of Esophageal Varices in Endoscopy-Naïve Child-Pugh A Cirrhotics
Bibliographic record
Abstract
Introduction: Bleeding esophageal varices cause significant morbidity and mortality in patients with cirrhosis. While various non-invasive strategies for variceal screening have been proposed, current guidelines recommend conventional esophagogastroduodenoscopy (EGD). The drawbacks of this approach include cost and risk of adverse events. Therefore, we propose the use of unsedated peroral thin scope endoscopy (TSE) as an alternative, minimally-invasive strategy. Methods: We retrospectively reviewed the 168 endoscopy-naïve patients with Child-Pugh A cirrhosis who underwent TSE for variceal screening at the University of Calgary outpatient liver clinic between September 2011 and July 2013. Baseline characteristics collected included diagnosis, age, sex, AST, platelet count, spleen size, and liver stiffness by transient elastography (FibroScan®). The MELD score, platelet count to spleen ratio (PSR), AST to platelet ratio index (APRI), and liver stiffness-spleen diameter to platelet ratio score (LSPS) were calculated for each patient. The tolerability of TSE was recorded. Findings of TSE, including the presence and size of varices, and the presence of non-variceal phenomena, were documented. Results: TSE was well-tolerated in 94% of cases, and no adverse events were reported. The rates of no, small, and medium/large esophageal varices were 72.0%, 17.9%, and 10.1%, respectively. Medium/large varices with high-risk stigmata were seen in 1.8% of patients screened. Portal hypertensive gastropathy was seen in 36.3% of patients. Gastric or duodenal ulcers were seen in 13.7% of patients, but none warranted intervention. Patients with varices did not have higher MELD scores than those with no varices (p=0.48). LSPS was the single best noninvasive predictor of patients with medium/large esophageal varices (area under the receiver operating characteristic, 0.83; 95% confidence interval, 0.72-0.93; p<0.001). Conclusion: TSE for the screening of esophageal varices in endoscopy-naïve patients with Child-Pugh A cirrhosis is safe and well tolerated. Varices were found in 28% of patients, but most did not require further endoscopic intervention. In-hospital sedated EGD was avoided in 88% of patients screened. LSPS may be able to descriminate between patients suitable for TSE, and those who should proceed directly to EGD.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".