A50 SUCCESSFUL HEMOSTASIS WITH THROUGH THE SCOPE CLIPS FOLLOWING OVER THE SCOPE CLIP FAILURE IN DIEULAFOY LESION
Bibliographic record
Abstract
Abstract Background Dieulafoy lesions account for 1-2% of acute GI bleeding and can be difficult to treat endoscopically. Aims We present a case a 59-year-old male who presented with hematemesis, melena, and hemodynamic instability. Methods Initial esophago-gastro-duodenoscopies (EGD) did not detect a source of active bleeding. Abdominal CT angiography revealed vascular structure in the stomach’s greater curvature, indicating a Dieulafoy lesion. Embolization via interventional radiology was unsuccessful. A third EGD finally showed the bleeding as a focal ooze localized in the proximal part of the greater curvature of the stomach. We used a padlock over-the-scope clip (OTSC). Despite successful deployment and placement of the OTSC, the bleeding persisted. Results Ultimately, hemostasis was achieved using five through-the-scope clips in a zipper fashion to the mound of tissue that had been raised by the over the scope clip. We hypothesize that although the OTSC grasped the Dieulafoy lesion, the feeding vessels were not significantly compressed to achieve hemostasis. This case demonstrates the failure of an OTSC to control bleeding from a Dieulafoy lesion, which was ultimately managed with through-the-scope clips. Conclusions This underscores the importance of combining traditional and novel endoscopic techniques to achieve hemostasis. Funding Agencies None
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| 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".