Finding the needle in the haystack: localization and endoscopic treatment of diverticular-associated lower GI bleeding
Bibliographic record
Abstract
A 74-year-old previously healthy male presented to the Emergency Department with 12 hour history of painless hematochezia. He had positive orthostatic vitals from supine to standing. Colonoscopy was performed, which demonstrated blood clots throughout the colon without evidence of blood in the terminal ileum. Withdrawal examination was significant for sigmoid predominant diverticular disease. No other source of bleeding was identified. We irrigated the sigmoid colon with water to clear blood clots and examine the underlying diverticular disease. Careful endoscopic examination identified a diverticulum with clot within the lumen, and irrigation of the clot showed an underlying visible vessel. The vessel was clipped (Figure 1A–D). Sigmoid colon diverticulum with clot within the diverticular lumen (A), underlying visible vessel following clot clearance (B) and subsequent clipping of the visible vessel (C–D). Diverticular bleeding accounts for approximately 20–40% of lower gastrointestinal bleeds (1). Management is generally supportive, as bleeding stops spontaneously in 70–80% of cases (2). Colonoscopy can help identify diverticula with stigmata of recent hemorrhage (SRH) such as active bleeding, visible vessels, and adherent clots, but the diagnostic yield may be as low as 20% (3). Identification of SRH can increase to 40% if colonoscopy is done early (<12 h) rather than late (48–72 h), although this does not necessarily lead to improved clinical outcomes (4). If the bleeding is localized, potential endoscopic therapies include injection, endoscopic band ligation, thermal contact, and endoscopic clipping. There was no funding associated with this manuscript. None of the authors have any conflict of interest relevant to the subject matter. There are no data associated with this manuscript.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 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".