S38 Plastic vs Metal Stents for Preoperative Biliary Drainage in Patients With Resectable Pancreaticobiliary Neoplasias: A Retrospective Study
Bibliographic record
Abstract
Introduction: Obstructive jaundice is a common consequence of pancreatic and biliary malignancies. In surgical candidates for oncological resection, biliary obstruction is associated with high rates of peri-operative complications. Preoperative biliary drainage (PBD) constitutes the mainstay of treatment in patients with severe hyperbilirubinemia, cholangitis, delayed surgery or awaiting neoadjuvant therapy. While both plastic and metal stents have been used in this clinical context, it remains unclear which type of stent would yield a better clinical outcome in patients with resectable tumors. Methods: We performed a retrospective analysis of all patients with resectable pancreaticobiliary malignancy and significant obstructive jaundice who underwent preoperative biliary drainage (PBD) and subsequent pancreaticoduodenectomy (Whipple procedure) with curative intent between January 2014 and December 2020 at the CIUSSS de l’Estrie CHUS, a Canadian tertiary center. Clinical outcomes including endoscopic reintervention, stent-related adverse events, and stent efficacy (defined as biochemical decrease of total bilirubin value before surgery) were evaluated and compared between plastic and metal stent groups. Results: 44 patients were comprised in the final database, including 29 and 15 patients in the plastic and metal stent groups, respectively. Baseline characteristics were comparable in both groups. There was significantly more need for endoscopic reintervention for stent dysfunction (27,5% vs 0% P=0,037) in the plastic stent group versus the metal stent group and a tendency towards more PBD-related adverse events (31% vs 6,7% P= 0,08). Reduction of 50% of total bilirubin value was seen at 11 days for the plastic stent group vs 19 days for the metal stent group (p = 0,349). Only 3 (20%) patients in the metal stent group and 6 patients (21%) in the plastic stent group normalized their total bilirubin value before surgery (p = 1). The time from biliary drainage to surgical resection was similar in both groups (34 vs 36 days p = 0,862). Conclusion: While both plastic and metal stents seemed to have similar clinical efficacy for preoperative biliary drainage in malignant obstruction in our study, metal stents had significantly lower rates of reintervention and a tendency towards less procedure related complications than plastic stents. While larger studies are needed to confirm this finding and its related cost effectiveness, it currently seems reasonable to consider metal stents in this clinical context.Table 1.: Performance and efficiency of metal vs plastic stents for preoperative biliary drainage (PBD)
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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) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| 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".