A329 CAN THE CALGARY BILE LEAK RULE AVOID THE NEED FOR REPEAT ERCPS IN OTTAWA? A VALIDATION STUDY
Bibliographic record
Abstract
ERCP with biliary stent placement is currently the standard treatment for postsurgical bile leaks. However, the best method (ERCP or gastroscopy) and timing of stent removal is controversial. The Calgary Bile Leak Rule suggests that patients who present with bile leaks after a laparoscopic cholecystectomy, have a normal postsurgical ALP, and have a small or no leak with no other pathology identified on initial ERCP can safely have their stent removed via gastroscopy 4 to 8 weeks after stent insertion. We aimed to validate this prediction rule using the Ottawa Advanced Endoscopy Service experience. A retrospective chart review of patients who were endoscopically managed for surgical bile leaks between 2005 and 2017 at The Ottawa Hospital (TOH) were identified. The primary outcome was presence of persisting bile leak or other pathology on follow-up ERCP. Sensitivity, specificity, and the positive and negative predictive values were calculated for the Calgary Bile Leak Rule. 71 cases met inclusion criteria and had sufficient data available to be considered for the validation analyses. 29 cases met most inclusion criteria but did not have sufficient data. 54 (76%) of bile leak cases had no leak identified during the follow-up ERCP and 17 (24%) had a persisting leak. The Calgary Bile Leak Rule demonstrated a sensitivity of 87% (95% CI, 75%-95%), a specificity of 6% (95% CI, 0%-29%), a positive predictive value of 75% (95% CI, 64%-85%), and a negative predictive value of 13% (95% CI, 2%-50%). The Calgary Bile Leak Rule demonstrated high sensitivity for predicting the need for repeat ERCPs after surgically induced bile leaks are treated with biliary stenting. Further evaluation using larger prospective data sources are needed prior to recommending this rule for clinical practice. 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 | 0.006 | 0.032 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 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".