Number, depth, and location of inadvertent pancreatic guidewire cannulations, and their association with post-ERCP pancreatitis: multicenter real-time intra-procedural data
Bibliographic record
Abstract
Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is common. Although multiple pancreatic duct (PD) cannulations are a known risk factor for PEP, the impact of single cannulations remains controversial. We aimed to identify whether single PD cannulation is associated with PEP. Methods: We conducted a prospective multicenter study in patients undergoing ERCP for biliary indications during 2021–2024, with third-party intra-procedural data recording and 30-day follow-up. PEP was defined using consensus definitions. Associations between PD cannulations and PEP were evaluated with multivariable logistic regression, with other patient- and procedure-related risk factors and preventative interventions used as covariates. Results were reported as odds ratios (ORs). Results: PEP occurred in 282 (3.8%) of 7430 ERCPs across nine centers. From multivariable analysis, PD cannulation was statistically significantly associated with PEP, with similar odds for single and multiple cannulations in first-time patients (OR 2.03 [95%CI 1.32–3.14] for single, OR 2.18 [95%CI 1.18–4.00] for ≥5 cannulations) and all patients (OR 1.97 [95%CI 1.33–2.93] for single, OR 2.15 [95%CI 1.21–3.82] for ≥5). PD cannulation to the head (OR 2.09 [95%CI 1.36–3.21]) and body (OR 2.43 [95%CI 1.56–3.79]) were both associated with PEP, while side-branch cannulations alone were not (OR 1.18 [95%CI 0.64–2.06]). Conclusions: Single main PD duct cannulation was independently associated with PEP and appeared to be responsible for most of the magnitude of the association with PD cannulation. These data support the use of preventative interventions such as PD stenting in cases where the PD is inadvertently cannulated.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".