Endoscopic Management of Concomitant Malignant Biliary and Gastric Outlet Obstruction
Bibliographic record
Abstract
Concurrent malignant biliary and gastric outlet obstruction requires urgent palliative intervention to improve patient quality of life and permit systemic therapy. Traditional management has been surgical gastrojejunostomy and hepaticojejunostomy, two morbid procedures. Comparatively, endoscopic stenting can relieve both sites of obstruction with less complications and quicker recovery. In patients with previous plastic biliary stents in situ, it is crucial for subsequent bilioduodenal obstructions to be managed with proper sequencing and precise stent placement to achieve successful bilioduodenal patency. We report a case of a 53-year-old male patient who presented with simultaneous jaundice secondary to blocked biliary stent and vomiting due to gastric outlet obstruction at the first part of the duodenum on background of unresectable pancreatic adenocarcinoma. Fourteen months prior, he had a plastic endobiliary stent placed for biliary obstruction secondary to choledocholithiasis, but intraprocedural cholangiogram also revealed a distal common bile stricture with subsequent investigations revealing unresectable pancreatic adenocarcinoma for which he underwent palliative chemotherapy. Duodenal stricture dilation with subsequent duodenal self-expanding metal stent was placed under direct endoscopic vision precisely proximal to the blocked biliary stent. After 48 hours, endoscopic retrograde cholangiopancreatography was then performed through the duodenal stent to exchange the blocked plastic biliary stent for a metal biliary stent. The patient had prompt relief of jaundice and tolerated oral intake by date of discharge post-procedure day two and was initiated on chemotherapy on post-procedure day 12. Endoscopic stenting of concomitant biliary and gastric outlet obstruction can be successful in patients with occluded indwelling plastic biliary stents.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".