A213 ERCP-RELATED ADVERSE EVENTS IN PRIMARY SCLEROSING CHOLANGITIS: A SYSTEMATIC REVIEW & META-ANALYSIS
Bibliographic record
Abstract
Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic tool in primary sclerosing cholangitis (PSC). Although the complications of ERCP are well known in the general population, there is conflicting data regarding complications in patients with PSC. Factors that predict ERCP-related adverse events in PSC are also unclear. Aims To conduct a systematic review and meta-analyses to 1. compare ERCP-related adverse events in patients with and without PSC and 2. determine risk factors associated with ERCP-related adverse events in PSC. Methods A systematic search was conducted in Embase, PubMed and CENTRAL for studies published from January 1, 2000 to May 12, 2021. Eligible studies included adults with PSC undergoing ERCP and reported at least one ERCP-related adverse event (bleeding, perforation, pancreatitis, cholangitis) or risk factor associated with complications. Raw event rates for adverse events and risk factors were used to calculate odds ratios (ORs) which were then pooled using random-effects models. Results Four studies contributed to the first meta-analysis. There was a significant three-fold increase in the 30-day odds of cholangitis in PSC compared to those without PSC (4.3% vs. 2.0%; OR 3.26, 95% CI 1.08–9.90; p=0.037; I2=73.0%) (Figure 1). However, there were no significant differences in 30-day pancreatitis (4.2% vs. 3.4%; OR 0.89, 95% CI 0.26–3.07; p=0.851; I2=87.9%), bleeding (0.3% vs. 1.1%; OR 0.36, 95% CI 0.06–2.21; p=0.272; I2=50.3%), or perforation (0.7% vs. 0.5%; OR 1.19, 95% CI 0.40–3.51; p=0.752; I2=28.5%). In a second meta-analysis, risk factors contributing to post-ERCP pancreatitis (PEP) in PSC were pooled from five studies. While female sex was not associated with PEP, accidental passage of wire into the pancreatic duct (OR 7.44, 95% CI 3.33–16.65; p<0.001; I2=65.0%) and biliary sphincterotomy (OR 4.80, 95% CI 1.92–12.03; p=0.001; I2=73.1%) were associated with higher PEP odds. Conclusions In the context of limited comparative data and study heterogeneity, PSC patients have higher odds of post-ERCP cholangitis despite the majority receiving antibiotics. Odds of bleeding, pancreatitis, and perforation were similar between groups. Accidental wire passage and biliary sphincterotomy increased odds of PEP, which helps identify higher-risk groups. Future studies should elucidate ERCP-related risks in PSC and guide preventive strategies. Figure 1: 30-Day ERCP Complications 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 | 0.014 | 0.033 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.052 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".