S2204 The Value of EGD With EUS or ERCP: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreaticography (ERCP) are common endoscopic procedures performed for the diagnosis and management of various gastrointestinal conditions. However, luminal or mucosal pathology may be missed due to the “side-viewer” nature of these endoscopes. Some endoscopists advocate for the use of standard forward-view prior to EUS/ERCP to evaluate for clinically significant pathology. Our aim was to evaluate the clinical utility and efficacy of esophagogastroduodenoscopy (EGD) before or after EUS/ERCP through a systematic review and meta-analysis. Methods: Following PRISMA and MOOSE guidelines, a systematic review was conducted in PubMed, EMBASE, Cochrane and Web of Science from inception to date for identifying studies on outcomes of EGD before or after EUS/ERCP. Search strategy was performed with the aid of a librarian. The primary outcome was pooled number/percentage of lesions noted on EGD which would have been otherwise missed on EUS. Secondary outcomes are clinically significant lesions as defined in relevant studies and number of missed lesions. Pooled estimates were calculated using a random effects model with 95% confidence interval (CI). Heterogeneity was assessed with I2 statistics and Q testing. Publication bias was assessed via visually inspected for asymmetry and quantitatively assessed using Egger regression testing. Results: A total of 7 studies (n=1737 patients) were included in this analysis. Four studies were retrospective, 2 studies were prospective, and one study was a tandem prospective, blinded trial. Mean age of included patients was 68.87 (57-71) years, with 50.02% women. The rate of all findings detected on EGD alone was 20.01% [(95% CI, 9.16-38.28); I2=97.74; Q-value 265.30] – (Figure 1A). In total, forward viewing EGD found more lesions than EUS or ERCP at a rate of 9.68% [(95% CI, 4.17-20.90); I2=96.50; Q-value 171.51]. A total of 6 studies (n=1562) examined difference in clinically significant findings, defined as those that required change in management. These were noted for 8.54% [(95% CI, 3.86-17.82); I2=94.78; Q-value 85.87] of patients – (Figure 1B). There was no evidence of publication bias. Conclusion: Esophagogastroduodenoscopy with EUS or ERCP routinely diagnoses clinically significant pathology that may be otherwise missed and therefore should be performed with each EUS and ERCP routinely.Figure 1.: 1A) Rate of all Findings on EGD Alone Figure 1B) Rate of Clinically Significant Findings on EGD Compared to EUS/ERCP. EUS, endoscopic ultrasonography; ERCP, endoscopic retrograde cholangiopancreaticography; EGD, esophagogastroduodenoscopy.
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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 | 0.019 | 0.049 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.036 |
| Bibliometrics | 0.011 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 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".