Safety and Efficacy of Endoscopic Mucosal Resection of Large Nonpedunculated Colorectal Polyps with Margin, Base and Vessel Ablation: A Prospective Multi-Center Study
Notice bibliographique
Résumé
Aims Endoscopic mucosal resection (EMR) is the mainstay of therapy for large colorectal polyps. A previous study from our group has shown low adverse events and low recurrence rates after EMR with margin and selective base ablation using hybrid argon plasma coagulation (hAPC) [ 1 ]. We were interested in evaluating, in a second study phase, the safety and efficacy of EMR with systematic margin, complete base and vessel ablation using hAPC in a multicenter prospective setting and to evaluate combined outcomes over these two study phases. Methods Adults (18–89 years) undergoing EMR of nonpedunculated colorectal polyps≥20mm were enrolled consecutively in a prospective multicenter study from 2019 to 2024 in Canada (University of Montreal, University of Toronto, University of British Columbia) and the United States (Penn State College of Medicine). In the first study phase, patients received margin ablation using hybrid argon plasma (hAPC) after EMR, with additional therapies at the discretion of the endoscopist including selective base ablation, defect clipping and/or prophylactic treatment of visible vessels. In the second study phase, patients received, after EMR completion, systematic ablation of the post-resection margin, the complete base and any visible vessels using hAPC, with vessel ablation as the primary prophylactic therapy for bleeding. The co-primary outcomes were adverse events within 30 days, including severe post-endoscopic bleeding, and the proportion of local recurrence at the first surveillance colonoscopy (SC1), based on image-enhanced endoscopy and biopsies of the scar and based on histology of resected visible recurrences. Results A total of 239 patients (mean age 66.5 years, 46.4% female) were included and underwent 269 EMRs (mean polyp size 34.4 mm, 78.4% proximal to the splenic flexure, 96.3% piecemeal resections). Epinephrine was injected and/or used in the hAPC solution in 98.9%. Margin ablation was performed in all cases, and partial or complete base ablation was performed in 229 cases (85.1%). Prophylactic therapy of visible vessels was performed in 141 cases (52.4%) using hAPC ablation of visible vessels for the majority (108/141, 76.6%). Defect clipping was performed in 56 cases (20.8%). Severe post-endoscopic bleeding occurred in 2.2% [95% CI, 0.8-4.8] (6/269). Non-severe post-endoscopic bleeding occurred in 4.5% [95% CI, 2.3-7.7] (12/269). Post-procedural perforation occurred in 0.7% [95% CI, 0.1-2.7] (2/269). At SC1, performed at a median of 5.8 months, the overall local recurrence rate was 2.2% [95% CI, 0.8-4.8] (6/269). Conclusions In a prospective multicenter study, EMR with selective or complete hAPC ablation of the resection base and visible vessels in addition to margin ablation demonstrated high technical success, low adverse events and low recurrences. A randomized controlled trial is ongoing to compare the safety and efficacy of base and margin ablation to margin ablation only. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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 | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 ».