A102 INDICATION FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND ASSOCIATION WITH HEMORRHAGE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Abstract Background Hemorrhage is a complication associated with up to 2% of cases of Endoscopic Retrograde Cholangiopancreatography (ERCP), most commonly following sphincterotomy. Studies investigating risk factors associated with hemorrhage, such as ERCP indication, have been conflicting. Aims We performed a systematic review and meta-analysis to determine the association between the indication for ERCP and ERCP-associated hemorrhage. Methods A systematic search of MEDLINE, EMBASE, and CENTRAL was done from inception until September 2021 for studies reporting on factors associated with ERCP-associated hemorrhage (both immediate and delayed) in adults. Exclusion criteria included: pediatric patients, no outcome of interest, did not investigate hemorrhage risk factors, inappropriate study design (basic science, reviews, and case reports/series), or if no English text was available. A DerSimonian and Laird random-effects meta-analysis was performed to generate pooled Odds Ratios (OR) with 95% Confidence Intervals (CIs) for each procedural indication in relation to hemorrhage. Results 952 records were identified of which 17 were included in our quantitative analysis. Common indications included acute cholangitis, choledocholithiasis, Sphincter of Oddi dysfunction (SOD), acute pancreatitis, chronic pancreatitis, and malignancy-associated duct obstruction. Rates of hemorrhage varied in the included studies (median 2.2%; IQR 1.7–6.9). Sphincterotomy rates also differed in the included studies (median 100%; IQR 71.1–100). Five studies did not report on antiplatelet or anticoagulant use with the remaining reporting varying rates of antiplatelet (median 8.3%; IQR 0–26.5) and anticoagulant (median 0.8%; IQR 0–2.25) use. Hemorrhage was significantly associated with acute cholangitis (OR 2.48; 95% CI 1.62–3.78) and choledocholithiasis (OR 1.76; 95% CI 1.06–2.94) but not SOD (OR 1.38; 95% CI 0.74–2.58), malignancy (OR 0.68; 95% CI 0.29–1.59), acute pancreatitis (OR 1.08; 95% CI 0.30–3.82), or chronic pancreatitis (OR 0.56; 95% CI 0.16–1.99). Conclusions Acute cholangitis and choledocholithiasis were associated with increased hemorrhage, whereas SOD, malignancy, acute pancreatitis, and chronic pancreatitis were not. Providers should consider procedural indication when counselling patients on hemorrhage risk in ERCP. Funding Agencies None
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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 | 0.009 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.034 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 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".