A231 SINGLE GUIDEWIRE MAIN PANCREATIC DUCT CANNULATION AS A RISK FACTOR FOR POST-ERCP PANCREATITIS: FINDINGS FROM A MULTI-CENTER PROSPECTIVE ENDOSCOPY REGISTRY
Bibliographic record
Abstract
Abstract Background Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains a relatively common adverse event. Though multiple cannulations of the main pancreatic duct (PD) are a known risk factor for PEP, the impact of a single cannulation of the main PD remains controversial. Aims Given the importance of identifying those at risk for PEP, especially in light of the growing evidence for preventative interventions such as PD stenting, we aimed to identify if single PD cannulation is a risk factor for PEP. Methods We analyzed data from a multi-center, prospective registry collected from 2018-2024 with associated protocolized 30-day follow-up for patients undergoing ERCP for any biliary indication. PEP was defined as recurrent admission or prolongation of existing admission due to the development of characteristic abdominal pain occurring after ERCP with pancreatic enzyme elevation >3 times the upper limit of normal at least 1-day post ERCP and/or imaging findings characteristic of pancreatitis. The association of single PD cannulation and PEP was evaluated with multivariable logistic regression utilizing known risk factors and preventive interventions as covariates. Results were reported as odds ratios (OR) with associated 95% confidence intervals. Results PEP complicated 287 (3.8%) of the 7,479 ERCPs studied. Single main PD cannulation (OR 2.14, 1.45-3.12), and multiple main PD cannulation (OR 2.58,1.76-3.76), were independent risk factors for PEP in all comers. This trend was also maintained in those with native papilla for single PD (OR 2.20, 1.43-3.24) and multiple PD (OR 2.50, 1.65-3.77) cannulations. Single main PD cannulation to both the pancreatic head (OR 1.89, 1.02-3.30) and the pancreatic body (OR 2.61, 1.44-4.57) were associated with PEP compared to no main PD cannulation. Further, a trend towards increased risk with any number of side PD cannulations (OR 1.15, 0.63-2.00) was seen, though these analyses were likely underpowered. Conclusions Single main PD duct canulation, to the pancreatic head or body, represents an independent risk factor for PEP in this analysis. Additionally, there appears to be additive risk associated with multiple main PD cannulations and deeper main PD cannulations. These results highlight the risk of any degree of PD cannulation, supporting the potential utility of routine preventative interventions, such as PD stenting in these cases. 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 | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 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".