316. OMISSION OF ROUTINE PYLORIC PROCEDURES IN MINIMALLY INVASIVE ESOPHAGECTOMY: WHAT IS THE IMPACT ON PERI-OPERATIVE OUTCOMES?
Bibliographic record
Abstract
Abstract Pyloroplasty or pyloromyotomy is often undertaken during esophagectomy to improve conduit function and potentially reduce complications. Minimally invasive esophagectomy (MIE) frequently omits a pyloric procedure. The impact on peri-operative outcomes and the need for subsequent interventions on the pylorus are unclear. This study assesses the requirements for endoscopic balloon dilation of the pylorus (EPD) following MIE. Patients undergoing MIE from 2016–2020 were reviewed. Patients undergoing hybrid or open resection, or an intraoperative pyloric procedure were excluded. Demographic, clinical, and pathological data were reviewed. Data on the need for post-operative EPD in the short- and long-term settings were recorded. Univariable and multivariable analysis were performed as appropriate. 171 patients underwent MIE. There were no differences in age (p = 0.6), stage (p = 0.10) or ASA status (p = 0.52) between those requiring and not requiring EPD. Forty-three patients (25%) required EPD. Twenty-seven patients (16%) had EPD on their index admission. Seventy-five patients (43%) had a post-operative complication. There was a correlation between complications and the requirement for EPD both on the index admission (p < 0.001) and subsequently (p < 0.001). On multivariable analysis, there was no association between EPD and overall survival (p = 0.14). Eight patients (5%) required insertion of a feeding jejunostomy. Two patients underwent surgical pyloromyotomy for delayed gastric emptying. Although pyloroplasty or pyloromyotomy can safely be excluded during MIE, a quarter of patients will require post-operative EPD procedures, for delayed gastric emptying or as part of management of post-operative complications. The impact of excluding pyloric procedures on gastric emptying requires further study.
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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 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
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".