A48 PATIENT OUTCOMES OF A COMPLEX POLYP ASSESSEMNT COMMITTEE IMPLEMENTATION
Notice bibliographique
Résumé
Abstract Background Over the past two decades, the endoscopic approach to managing complex colonic polyps has shifted from surgery to advanced endoscopic techniques, including endoscopic mucosal resection (EMR) and Endoscopic Submucosal Dissection. Endoscopic methods are less invasive than surgery, reducing morbidity, mortality, and cost, but require additional time, training, and expertise. Despite guidelines recommending EMR as the first line option, surgical resection for complex non-invasive polyps remains common in Canada. A 2019 retrospective study revealed that 12.5% of large non-malignant polyps in Nova Scotia were treated with surgical resection. Subsequently, a Complex Polyp Assessment Committee (CxPAC) was established to assess polyps suitable for endoscopic resection, aiming to reduce unnecessary surgical procedures. Aims The project aims to examine the early outcomes of programmatic assessment and management of complex colorectal polyps though CxPAC. Methods A retrospective chart review was completed on all patients referred to Nova Scotia’s CxPAC between January 2022 and February 2024. Descriptive statics were calculated. Results In a 24-month study period, 99 patients were referred to the CxPAC, with 88 suitable for complex polypectomy. Among the 10 patients not deemed appropriate for the procedure, 7 were directed to surgery prior to any endoscopic intervention. The referral indication was polyp size (65.7%), size with challenging position (16.2%), challenging position alone (6.1%), residual/recurrent polyp (7.1%), and scarring/poor lift (5.1%). The mean patient age was 66 (SD, 12), and the mean polyp size was 37mm (SD, 17). There were 18 patients referred for surgical management: 2 based on referral image review, 10 after endoscopic or post-resection pathology appearance positive for invasive carcinoma, 1 after perforation, and 5 after incomplete resection. Follow-up endoscopies have been performed on 61 patients. Among the 40 patients deemed clear during follow-up endoscopy, 8 did not have a biopsy at the polypectomy site. Of the 32 patients who did undergo biopsies, 20 exhibited normal mucosa, 8 showed reactive changes/scarring post-polypectomy, 2 were diagnosed with tubular adenomas, 1 with a sessile serrated adenoma, and 1 with a hyperplastic polyp. There were 9 instances of severe adverse events related to complex polypectomy: 5 cases of post-polypectomy bleeding, 2 perforations, and 2 emergency department visits due to abdominal pain. Conclusions The CxPAC has been effective for assessing and managing complex non-malignant colonic polyps, with 88.6% of patients able to avoid surgery. While endoscopic resection of complex polyps is a safer alternative to surgery, procedural risks remain, highlighting the importance of additional training on the part of the endoscopists and a detailed discussion and consent process with the patients. Funding Agencies 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 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,002 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
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 ».