Patient Position and ERCP Outcomes in Patients with Surgically Altered Foregut Anatomy
Bibliographic record
Abstract
Aims Patients with surgically altered gastrointestinal anatomy undergoing endoscopicretrograde cholangiopancreatography (ERCP) pose challenges due to anatomicaldistortions. Factors such as patient positioning, endoscopist experience, andchoice of endoscope may influence procedural success. It is unclear how thesefactors may impact the technical success of ERCP among patients with alteredanatomy. We primarily aimed to determine the impact of patient positioning (proneversus left lateral decubitus [LLD]) on technical success of ERCP among patientswith surgically altered anatomy. We also considered the impact of endoscopistexperience and endoscope type, alongside patient positioning. Methods We conducted a retrospective single-centre study using data from 2010 to 2020that included patients with hepaticojejunostomy, Roux-en-Y anastomosis, Billroth1, or Billroth-2 anatomy. The primary outcome was technical success of the ERCP,which we comprehensively defined as of successful navigation to the papilla orsurgical anastomosis, selective cannulation and cholangiography, and therealization of the intended therapeutic goals. The secondary outcomes were thepresence of immediate bleeding and procedural time. Statistical analysis involveddescriptive statistics using mean and standard deviation (SD) and Fisher exacttest with relative risk (RR) and 95% confidence interval (95% CI). All statisticaltests were two-tailed and considered significant at P<0.05. Results Among 205 patients, 179 were in the LLD group, and 26 were in the prone group.Patient demographics did not significantly differ between groups. The choice ofendoscope (P=0.011) and endoscopist experience (P<0.001) were the onlyvariables with significant differences. There were no significant differencesbetween the two groups in terms of procedural success (RR 1.1, 95% CI: 0.8-1.5),immediate bleeding (RR 1.7, 95% CI: 0.2-14.8), and procedural time (P=0.808).Patients in the left lateral decubitus (LLD) position had a significantly higherlikelihood of technical success compared to those in the prone position (OR 2.59,95% CI 1.09-6.14, p=0.031). Additionally, non-Roux-en-Y reconstructions wereassociated with significantly higher technical success rates than Roux-en-Yreconstructions (OR 0.354, 95% CI 0.182-0.690, p=0.002). Conclusions We found that patient positioning had a significant impact on technical success inERCP among patients with surgically altered anatomy. The choice of positioningshould be tailored optimizing outcomes in this complex patient subset. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".