A40 FACTORS AFFECTING MEGAPOLYPECTOMY SUCCESS
Notice bibliographique
Résumé
Endoscopic management of large colon polyps is increasingly favoured over surgical resection. However, complete resection of polyps 3 cm or larger, called megapolyps, is challenging with associated risks of bleeding, perforation, and unsuccessful resection. There are numerous factors that may impact success in megapolypectomy. Evaluate the success rate of attempted megapolypectomy performed at The Ottawa Hospital, and identify factors which may impact success. Additionally, we reviewed complications associated with megapolypectomy. All endoscopic procedures at TOH are flagged based upon indication and all those from 2008 onward were captured. In addition, patients were identified retrospectively using a specific billing code for endoscopic removal of polyps 3cm or larger. Chart review was performed for data collection. 356 patients with a mean age of 67 y/o and a ratio of 1:1.4 female to male patients were identified for the study. 244 megapolypectomies were successful as defined by the absence of adenoma in 4 to 6 months follow-up. In 17 cases, where the endoscopist opined a complete resection, recurrence was found on 6 to 24 months follow up. 28 patients were referred to surgery, and 67 had no follow-up information available. The 28 polyps referred to surgery were on average 4.0cm of size, and the pathologist identified in samples no disease(28.7%), high-grade dysplasia(14.2%), and malignancy(57.1%). The endoscopist was not able to complete the resection during the first intervention of 12 cases due to non-lift sign (50%) or difficult resections (50%). The remaining 16 cases had a series of endoscopic interventions to remove residual adenoma leading to the decision of referring the patient for surgical resection due to the inability of completing the resection. Of the successful megapolypectomies, the average number of interventions required for completion was 1.3 for 3-4cm polyps, and 1.6 for 4.1–5 cm polyps (P=0.0047). On average the therapeutic endoscopists removed 3.7cm polyps successfully compared to gastroenterologists removed 3.3cm polyps successfully (P=0.043). We observed a rate of 22.6 % (N=235) incorrect impression for the first intervention. The complication rate of megapolypectomies was found to be 7.6%. 25 were bleeds (93%) and 2 were perforations (7%). The overall success rate of megapolypectomy at The Ottawa Hospital is 93%. Failed resections are associated with increased polyp size, polyp location, high-grade and greater dysplasia, and increased interventions. Although endoscopists appeared confident in having performed a complete resection, in 22.6% of the failed resections, the endoscopist’s impression was incorrect. None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».