Endoscopic ultrasound-guided gallbladder versus bile duct drainage for first-line therapy of malignant biliary obstruction: international multicenter trial
Bibliographic record
Abstract
Abstract Background Endoscopic ultrasound (EUS)-guided gallbladder drainage (GBD) and EUS-guided choledochoduodenostomy (CDS) with lumen-apposing metal stents are alternative approaches to endoscopic retrograde cholangiopancreatography. We compared EUS-GBD and EUS-CDS as first-line therapies in the management of distal malignant biliary obstruction (MBO). Methods This was an international, multicenter, retrospective, observational study at 28 tertiary care centers from April 2017 to August 2024. Outcomes were compared using propensity score matching. The primary outcome was clinical success. Secondary outcomes included technical success, adverse events, and overall survival. Results 291 patients (mean age 74 [SD 12] years; 130 male) underwent EUS-guided drainage (82 EUS-GBD, 209 EUS-CDS). Most patients developed distal MBO from pancreatic cancer (84 %). After 1-to-1 propensity score matching, 154 patients were selected (77 per group). EUS-GBD and EUS-CDS had similar rates of technical success (96 % [95 %CI 89 %–99 %] vs. 99 % [95 %CI 92 %–99 %]; P = 0.36) and clinical success (86 % [95 %CI 75 %–92 %] vs. 92 % [95 %CI 83 %–97 %]; P = 0.17), respectively. Overall, 11 patients (14.2 % [95 %CI 7 %–24 %]) in each group experienced an adverse event, of which 6 in each group (8 % [95 %CI 2 %–16 %]) were serious. Conclusion Our study showed that in patients with distal MBO, the use of EUS-GBD or EUS-CDS were comparable, with similar rates of efficacy and safety. EUS-GBD could represent an easy and safe option in patients with DMBO without previous cholecystectomy and with clear patency of the cystic duct.
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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 | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| 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".