The role of peroral cholangioscopy in liver transplant recipients: A prospective, international series
Bibliographic record
Abstract
Background Biliary strictures are a common complication of living and deceased donor liver transplantation. Peroral cholangioscopy (POCS) with POCS-guided biliary tract biopsies may improve diagnostic accuracy compared to endoscopic retrograde cholangiopancreatography (ERCP) with biopsy, but the role and clinical impact of adding POCS to ERCP in management of post-liver-transplantation biliary adverse events remains unknown. Methods In a multicenter prospective study, patients ≥1 month post-liver transplantation with abnormal imaging and/or liver tests, without prior treatment of a biliary stricture, and referred for ERCP evaluation of a suspected biliary stricture underwent POCS immediately following the initial diagnostic portion of the ERCP. Outcomes were POCS visual impression of the stricture, impact on patient management and diagnosis, and related serious adverse events (SAEs). Results Forty-one patients (88 % cadaveric donors, mean 28 ± 44 months since liver transplantation) underwent POCS (mean POCS procedure time 25.7 ± 19.5 min). Stricture was confirmed by POCS in 38 patients (93 %) treated with balloon dilation (2), biliary stent(s) (7) or both (28), or with percutaneous drainage (1). Three patients without POCS-confirmed stricture had an angulated duct (2) or a cast (1). POCS influenced patient management in 26 (63 %), and diagnosis in 19 patients (46 %). POCS-guided selective guidewire placement was achieved in 12 cases (29 %) that failed during ERCP. No POCS-related SAEs were reported. Conclusions When added to standard-of-care ERCP, POCS showed diagnostic value and helped change patient management in over 60 % of patients, with no POCS-related adverse events. The greatest impact was in visual enhancement and facilitating guidewire access to the donor ducts.
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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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".