COMPARING OUTCOMES OF ERCP UNDER CONSCIOUS SEDATION TO GENERAL ANESTHESIA
Bibliographic record
Abstract
Aims In Canada, ERCP performed under conscious sedation (CS) is the standard of care but is limited by patient movement and agitation, especially in the context of lengthy or technically complex cases. General anesthesia (GA) may optimize patient comfort and safety while reducing complications such as pancreatitis, perforation, and mortality. In October 2017, Kelowna General Hospital (KGH), in British Columbia, Canada, transitioned the standard anesthesia modality for ERCP from CS to GA. This study investigated differences in complications and patient outcomes for ERCP performed under CS (n=1334) before the practice change compared to GA (n=899) after the practice change. Methods Our study is a pre-post retrospective chart review of 2,233 patients who underwent ERCP between 2015 and 2020 at KGH. Demographic, clinical, and procedural data were extracted from patient charts, and analyzed using univariate statistical analysis. Results Rates of post-ERCP pancreatitis (6% vs. 4%; p=0.018) and rates of procedure failure (8% vs. 3%; p<0.001) were statistically significant and higher in the CS cohort compared to GS cohort. These results were significant despite the average Charlson Comorbidity Index Score, a measure of the number and severity of patient disease comorbidities, being higher in the GA cohort. The rates of 30-day mortality, ICU transfer, return rates post-discharge, and cholangitis were similar. Conclusions Performing ERCP under GA rather than under CS is a valuable practice change that should be considered by ERCP-related programs due to its potential to reduce procedure failure and is associated with lower post-ERCP pancreatitis rates. Publication History Article published online: 14 April 2022 © 2022. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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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 | 0.002 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 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 | 0.000 | 0.001 |
| Research integrity | 0.000 | 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".