EP.FRI.986Life threatening bleeding duodeno-jejunal flexure GIST successfully managed with surgery- Case report
Bibliographic record
Abstract
Abstract Introduction Gastrointestinal stromal tumours (GISTs) are sarcomas and the most common non-epithelial cancers of the GI tract. Patient A 77-year old man with life threatening melaena, drop in haemoglobin from 109 to 71 in 24 hours and hypotension. Co-morbidities included COPD, chronic microcytic anaemia, type 2 Diabetes mellitus and hypertension. Anaemia for 9 years had been investigated with OGD and colonoscopy showing no pathology. Calculated Rockall score was 6. An Urgent Oesophagogastroduodenoscopy showed normal findings with no source of bleeding identified. An urgent CT angiography demonstrated a vascular blush at duodenojejunal (DJ) flexure identified as the source of bleeding. Four units of was blood transfused preoperatively. The bleeding source was not embolisable. He underwent an initial diagnostic laparoscopy to confirm the site of the lesion and ascertaining whether resection and anastomosis would be visible. Findings at laparoscopy included a DJ flexure lesion. A midline mini-laparotomy, wedge resection of the lesion with a hand-sewn anastomosis was performed. He had a prolonged hospital stay with gastroparaesis and high nasogastric tube output. Histology showed a well-demarcated, lobulated bland spindle cell lesion. The tumour is composed of cells with mainly blunt ended nuclei. There is strong positive staining to CD117 and DOG-1. There is focal positive staining to Desmin and SMA. The tumour is negative for S100 AND but Pankeratin. Overall, MDT felt that this was a 30mm DJ flexure GIST with less than 5 mitoses per 50mm2. R1 achieved resection but with a low risk (4.3%) of recurrence based on the histological characteristics.
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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 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.063 | 0.030 |
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".