Successful percutaneous transgastric diversion of a chronic post-operative combined pancreaticocutaneous and gastrocutaneous fistula using a snare-target technique
Bibliographic record
Abstract
INTRODUCTION: Gastrocutaneous fistula complicating a post-operative or post-pancreatitis pancreatic fistula is uncommon, but has a high mortality rate and typically occurs 6-9 weeks after initial drainage. Conventional methods of treatment may be limited by the size of the fistula tract and visibility. PRESENTATION OF CASE: complicated by a separate gastric fistula sharing the same cutaneous tract along the inserted drain as well as recurrent symptomatic pleural effusions requiring repeat hospitalizations for management. The chronic fistula tract was too small for conventional direct puncture under fluoroscopic or endoscopic ultrasound guidance; therefore, percutaneous transgastric diversion of the combined pancreatico-gastrocutaneous fistula using a snare-target approach was performed with complete resolution of clinical symptoms. DISCUSSION: Complicated pancreatico-gastrocutaneous fistulae are rare and typically require drainage, either surgically or via percutaneous direct transgastric puncture or endoscopic-ultrasound guided stent insertion. This case report demonstrates that a minimally-invasive percutaneous snare-target approach can be effective in treating complex fistulae too small to be accessed through these conventional methods. This case also demonstrates that transgastric drainage along the tract, remote from either organ's fistula origin, can successfully divert and resolve the complex fistula without requiring direct drainage of the pancreatic duct itself. CONCLUSION: Incorporating the snare-target technique facilitates accurate transgastric drain placement within chronic fistula, particularly when the fistula caliber is too small for conventional drainage methods.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| 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".