THE YIELD OF FOCUSSED ENDOSCOPIC ULTRASOUND IN PATIENTS WITH UNEXPLAINED DILATATION OF COMMON BILE DUCT AND OR PANCREATIC DUCT AND CORRELATION WITH LIVER FUNCTION TESTS
Bibliographic record
Abstract
Aims To investigate factors that are associated with positive findings at EUS in patients with dilated ducts and correlation with LFTs. Methods Patients with EUS for unexplained dilated CBD and/or PD from 2012 to 2016 with available LFTs were included. CBD dilatation was defined as CBD diameter greater than 7mm with PD diameter more than 4 mm in the head and 3 mm in the body and tail was considered dilated. LFTs checked were bilirubin, ALT (alanine aminotransferase), ALKP(alkaline phosphatase) and GGT(gamma-glutamyl transferase). Elevated LFTs were defined as elevation of anyone of the above . Results Among 2179 EUS procedures, 404 patients met the study criteria. 58.4% were female with mean age of 61.72±15.11 and 293/404 had elevated LFTs. 74% of patients had more than one imaging modality before EUS. EUS found a cause of dilated duct in 57% of total cases. Males (65%, p=0.008), patients with dilated CBD and PD (67% p=0.009), elevated bilirubin (72.6% p=0.000) and elevated AKLP (62.3% p=0.049) were associated with positive findings on EUS. In patients with CBD dilatation alone, elevated bilirubin as compared to normal bilirubin was associated with a positive finding on EUS (p< 0.027) (66% of cases). In those with CBD and PD dilatation, age over 60 years (p=0.000), raised bilirubin (p< 0.022) and Alkaline Phosphatase (p< 0.018) were associated with positive findings (78.2%, 81.6% and 76.6%respectively.) The predictors of positive findings on EUS in Multivariate analysis were: bilirubin (OR 2.07(CI 1.19-3.59) and male gender (OR 1.7(CI 1.14-2.25). Conclusions EUS detects pathology missed on prior radio logical imaging in 57% of patients with dilated CBD and or PD especially in males and with raised bilirubin. We recommend early access to a diagnostic EUS in the diagnostic pathway of patients with dilated CBD and or PD.
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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 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| 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".