S5218 Unmasking a Hidden Risk: Delayed Gastric Bleeding Post-EUS Liver Biopsy in a Cirrhotic Kidney Transplant Candidate
Bibliographic record
Abstract
Introduction: Liver biopsy is essential for diagnosing many liver diseases. Endoscopic ultrasound liver biopsy (EUS-LB) has emerged as a minimally invasive alternative to the traditional percutaneous or transjugular liver biopsy technique. EUS-LB facilitates access to both the lobes of the liver and allows measurement of portal pressure. Most complications include abdominal pain, subcapsular hematoma, acute pancreatitis, infectious complications, and bile leak. Overall bleeding rates range from 0.13% to 0.9%, with most cases involving mild, self-limited bleeding that rarely requires intervention. Case Description: We present the case of a 37-year-old man with end-stage renal disease secondary to hypertension, who is on hemodialysis. He underwent EUS-guided liver biopsy with fine needle aspiration using a 19-gauge Acquire needle. As part of the kidney transplant eligibility evaluation, samples were obtained from the right and left hepatic lobes by passing through the stomach and duodenal bulb. Patient was discharged stable without complications after procedure. However, 3 days later, he presented to the emergency department with melena, hematemesis, and a hemoglobin level of 5 g/dL. He also reported missing 2 hemodialysis sessions. Two units of packed red blood cells were transfused, and urgent hemodialysis was performed. An emergent esophagogastroduodenoscopy revealed 2 discrete puncture sites with active bleeding, which was unmasked by water irrigation, consistent with previous biopsy sites. Endoclips and PuraStat application achieved hemostasis. Histopathology confirmed hepatocellular cirrhosis. Discussion: EUS-FNB has a relatively low complication rate of 0.03% to 0.15%, with bleeding representing approximately 1.2% of all complications. A near-fatal case of hemorrhagic shock following EUS-FNB was reported in Quebec, Canada. Advanced kidney disease with consequent platelet dysfunction may be a risk factor for such bleeding. This case highlights the importance of remaining vigilant to the potential of delayed gastrointestinal bleeding secondary to platelet impairment in the setting of azotemia.
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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) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".