S1216 Is Endoscopic Bile Duct Stenting a Risk Factor for Post-ERCP Pancreatitis? A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Placement of a stent in the bile duct could potentially block pancreatic duct orifice, which may result in post-ERCP pancreatitis (PEP). Although bile duct stenting is the most commonly performed intervention during ERCP, its association with the development of PEP has been examined less frequently. Additionally, the results of association of PEP with bile duct stenting are inconsistent in these studies. The aim of this meta-analysis is to evaluate the risk of PEP with the placement of biliary stent. Methods: A literature search of several electronic databases was performed for all the published studies reporting the association of bile duct stenting and PEP. The Inverse Variance method was used to pool data of PEP outcomes in a random effects model. Odds ratio (OR) was used to generate an overall effect estimate of the outcome. Association of PEP with bile duct stenting was calculated separately for pooled univariable OR values as well as pooled multiple-logistic regression OR values. Publication bias was assessed by contour funnel plot and heterogeneity was calculated by I2 test. Methodological quality of the studies was assessed by Newcastle-Ottawa scale. Results: We identified 30 studies (7 prospective and 23 retrospective) with a total of 820,325 patients in the meta-analysis. Of these patients, 205,521 underwent endoscopic biliary stenting. The incidence of PEP varied from 1.2-10.8%. Bile duct stenting was included in multi-variate model in 20 of 30 studies and OR was reported in 18 of these studies. Pooled OR with 95% confidence interval (CI) by univariate analysis showed an increase in the risk of PEP with placement of bile duct stent (OR=1.61;CI:1.06, 2.46), Cochran Q test P< 0.00001. I2=98% (Figure 1A). Pooled OR by multi-variate analysis also showed a higher risk of PEP with biliary stenting (Figure 1B). Sensitivity analysis was performed after excluding studies where International Statistical Classification of Diseases and related Health Problems (ICD) codes were used for identifying PEP which revealed a pooled adjusted OR of 2.12 (95% CI 1.48, 3.02), Cochran’s Q test P< 0.0001, I2= 69%. Funnel plot appeared asymmetric, however Duval and Tweedie’s random effects model did not reveal any trimmed studies. Only 2 studies were moderate quality, while other studies were high quality per Newcastle-Ottawa assessment scale. Conclusion: Bile duct stenting is associated with a modest increase in the risk of post-ERCP pancreatitis.Figure 1.: A) Pooled Odds Ratio (OR) with 95% confidence interval (CI) by univariate analysis. B) Pooled OR by multi-variate analysis with corresponding CI.
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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 | 0.014 | 0.034 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.034 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".