Comparable long-term efficacy of cold and hot EMR of large colon polyps – follow up results of a randomized trial
Notice bibliographique
Résumé
Aims Although safer, cold endoscopic mucosal resection (EMR) of large (≥ 20 mm) non-pedunculated polyps has been shown to have a high recurrence rate of>25% at first surveillance colonoscopy (SC1). The efficacy of treating recurrence at SC1 is unknown. The aim of this study was to compare recurrence between cold and hot EMR of large non-pedunculated colorectal polyps at second surveillance colonoscopy (SC2). Methods This is a follow-up study of a randomized trial of 660 patients undergoing cold or hot EMR of large non-pedunculated colorectal polyps at 15 centers in the US and Canada. We performed an interim analysis of all patients who have completed SC2. Treatment of recurrence was at the discretion of the endoscopist. Primary outcome of interest was recurrence/residual rate of neoplastic polyps at SC2. Secondary outcomes include proportion of polyps with no recurrence at S1, but recurrence at SC2. We further examined characteristics of recurrent/residual polyps. Results 273 patients (44% of surveillance eligible patients) with 281 large polyps completed SC2 with examination of the resection site after a median of 19 months (148 in the cold EMR group and 125 in the hot EMR group). Among these patients, recurrence at SC1 was significantly greater following cold EMR (36.3%) compared to hot EMR (16.9%). Recurrence at SC2 was not different and occurred 12.7% in the cold EMR group and in 8.9% in the hot EMR group (p=0.304). Among those with recurrence at SC1, complete removal with no recurrence at SC2 was more often achieved in in the cold EMR group (80.7%) compared to the hot EMR group (57.1%, p=0.035). The proportion of polyps with no recurrence at SC1 but detected recurrence at SC2 was 5.7% and 1.6% (p=0.127), respectively. Recurrent median polyp size was similar (10 and 8 mm, respectively). Histology of recurrent polyps was also similar with 90.0% adenomas (5 tubulo-villous adenomas [TVA]) and 10.0% sessile serrated lesions (SSL) in the cold EMR group and 72.7% adenomas (2 TVA), 27.2% SSL (1 dysplastic) in the hot EMR group. One polyp in the hot EMR group contained high grade dysplasia; there was no cancer in any recurrent polyp. All recurrent polyps at SC2 could be removed. Conclusions In this large follow-up study long-term efficacy of cold EMR of large non-pedunculated polyps appears comparable to hot EMR at second surveillance colonoscopy, although incomplete SC2 follow-up data is a limitation. Management of recurrence is equivalent between cold and hot EMR. The high rate of new recurrence at SC2 after cold EMR suggests that SC1 biopsies should be taken even in the absence of visible recurrence (in contrast to hot EMR). Overall, the results lower concerns of an initial high recurrence rate following cold EMR, and that early recurrence can be adequately managed. ClinicalTrials.gov no: NCT03865537. 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 | 0,006 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,007 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,002 | 0,003 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 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 ».