Needle-knife polypectomy in the duodenum assisted by peristaltic tension
Bibliographic record
Abstract
A 46-year-old woman was referred for investigation of iron-deficiency anemia. History, examination, and laboratory investigation did not establish the cause. Fecal immunohistochemical testing was positive, and endoscopic evaluation was recommended (Video 1). EGD revealed a 0-1p polyp arising from the inferolateral wall of the second portion of the duodenum (Figs. 1A and B ). Snaring the lesion proved impossible despite repositioning attempts. Hemostasis clips were applied prophylactically to the polyp stalk (Figs. 1C and D). The stalk was then transected with a needle-knife (Fig. 1E), and the polyp was deposited into the gastric lumen to prevent loss of the specimen (Fig. 1F). Re-evaluation of the polypectomy site demonstrated no iatrogenic trauma or postpolypectomy hemorrhage (Fig. 1G). The specimen was then safely withdrawn from the patient (Fig. 1H). Histologic analysis demonstrated a fibroepithelial polyp with Brunner’s gland hyperplasia. Pedunculated Brunner’s gland adenomas arising from the second portion of the duodenum are rare. These hamartomatous polyps rarely become malignant and are usually asymptomatic. GI bleeding or obstruction may necessitate resection. Snare polypectomy of pedunculated polyps in the duodenum can be difficult because of distal migration of the lesion and angulation of the bowel. If used with caution, needle-knife transection facilitates polypectomy. In this case, safe transection was aided by peristaltic tension placed on the stalk. The greatest risk with this technique is inadvertent thermal damage to the bowel wall, perforation, or both. A ball-tip or hook-tip needle-knife may reduce this risk. All authors disclosed no financial relationships relevant to this publication. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI2Y2Q4YzBhODVkOGY2YTU1ZTc0NjUxMjUxZWExOTZjOSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc5NTc3MDI1fQ.W0msjkpeh__Wo2YhP3EW7sEaX1Jse7UIKXqCTFAkm7lLeHnK9I1Aem1og9dvEybc9JouALq2yMT1LfLZTuUfBLEu_1XFdyzWJrpbxWTIaOva3NP8Y12HnjnieN9omui7xK0d6WkUEcTuyZIf0sS9BdqATZfsQT4vKZZlRWtReGouSD9Fjo0f9Uu9FEsvLSxSn3pWnRGiWoEwPvKYU4kvsvNU56X3GDe09FJ2ix4cnOSz0eyv7cpxyhQGeJ2ktiMZWjgFIurM0Ht0rp219QF-OtaZ7BJJDjRjos1xCc8xMVC96WkYzZytXtZ3jVZgKkk-cUMM1iC5NPCqQne530_PrQ Download .mp4 (85.34 MB) Help with .mp4 files Video 1Duodenal polypectomy using a needle knife. Download .docx (.02 MB) Help with docx files Video Script
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 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".