S1130 Safety and Efficacy of Endoscopic Ultrasound-Guided Gallbladder Drainage Performed by Early Career Advanced Endoscopists: A Multicenter Experience
Bibliographic record
Abstract
Introduction: Endoscopic ultrasound-guided gallbladder drainage (EGBD) using lumen-apposing metal stents (LAMS) has increasingly become an option for patients with acute cholecystitis or symptomatic cholelithiasis who are not surgical candidates. Recent studies have shown EGBD to be safe and effective. However, these data come from experienced advanced endoscopists. There is currently no data regarding the safety and effectiveness of EGBD in the hands of early career advanced endoscopists. We aimed to evaluate the safety and effectiveness of EGBD performed by early career advanced endoscopists. Methods: This was a multicenter, retrospective analysis of all patients who underwent EGBD, performed by 7 early career advanced endoscopists. Early career advanced endoscopist was defined as within two years of graduating advanced endoscopy fellowship. Patient and procedural characteristics were recorded. Primary outcomes were technical and clinical success. Technical success was defined as the ability to place the stent within the gallbladder. Clinical success was defined as improvement or resolution of gallbladder related symptoms within 5 days of the procedure. Other outcomes included adverse events and procedure related mortality. Results: A total of 21 patients underwent EGBD. All advanced endoscopists were within 18 months of completion of an American Society for Gastrointestinal Endoscopy (ASGE) accredited advanced endoscopy fellowship. The indication was acute cholecystitis in 18 cases (86%) and symptomatic cholelithiasis in 3 cases (14%). 48% were female, 81% were inpatients and the mean age was 75 years. The mean platelets and INR were 247 K/cmm and was 1.2, respectively. Eight patients were on anticoagulation. The EGBD was performed with the transgastric approach in 15 cases (71%) and transduodenal approach in 6 cases (29%). Clinical and technical success were achieved in all cases. One patient developed post-procedural pain within 30 days and one patient required overnight admission overnight. No patients developed recurrent cholecystitis, bleeding, perforation, stent migration or death within 30 days. Ten patients (48%) had the LAMS removed and the average time to LAMS removal was 41 days. The median duration of follow-up was 75 days. (Table) Conclusion: Our findings suggest that endoscopic ultrasound-guided gallbladder drainage is safe and effective in the hands of formally trained early career advanced endoscopists. Table 1. - Patient and Procedural Characteristics Indication N = 21 patients Acute Cholecystitis 18 (86%) Symptomatic Cholelithiasis 3 (14%) Patient characteristics Female 10 (48%) Age 75 years (SD 12) Inpatient 17 (81%) Chronic kidney disease 3 (14%) Diabetes mellitus 11 (52%) Cirrhosis 1 (5%) Platelet count (K/cmm) 247 (SD 64) INR 1.2 (SD 0.22) Anticoagulation use Apixaban Enoxaparin 8 (38%)7 (33%)1 (5%) Procedure characteristics Site of Lumen Apposing Metal Stent placement Stomach Duodenum 15 (71%)6 (29%) Size of Lumen Apposing Metal Stent 10 mm x 10 mm 15 mm x 10 mm 14 (67%)7 (33%) Outcomes Technical success 21 (100%) Clinical success 21 (100%) Stent removed 10 (48%; average 41 days) Recurrent Cholecystitis 0 Length of follow-up (days, median) 75 Adverse events Any adverse event 2 (10%) Need for admission following procedure 1 (5%) Post-procedural pain within 30-days 1 (5%) Death within 30-days 0
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".