FACTORS ASSOCIATED WITH DIFFICULTY IN PROPHYLACTIC CLIP CLOSURE AFTER ENDOSCOPIC MUCOSAL RESECTION OF LARGE COLORECTAL POLYPS
Bibliographic record
Abstract
Aims: Evaluate factors associated with inability to achieve prophylactic complete clip closure of the mucosal defect after endoscopic mucosal resection (EMR) of large ≥20 mm non-pedunculated colorectal polyps. Methods: This is a post-hoc analysis of a multicenter, randomized trial (CLIP study – NCT01936948) and included all patients that were randomized to the clip arm. Main outcome was complete versus incomplete closure (partial or no closure). The defect was considered completely closed when there was no remaining visible mucosal defect and clips were less than 1 cm apart. Factors associated with clip closure were evaluated in multivariate analysis. Results: 458 patients (age 65, 58% men) with 494 large polyps were included. Complete clip closure of the resection defect was possible for 338 polyps (68.4%) and was not achieved for 156 (31.6%) polyps; 90 (18.2%) had partial and 66 (13.4%) no closure. Inability to completely close the resection defect was associated with polyp size, adenomatous vs. serrated histology, difficulties of establishing polyp access, incomplete submucosal lifting, and piecemeal resection ( Table ). Other factors evaluated such as patient characteristics, polyp location, polyp morphology according to Paris, type of submucosal injectate, cautery setting, or ablation of the resection margin were not associated with clip closure. Tab. 1: 150 Complete closure N = 338 polyps N = 313 patients No complete closure. N = 156 polyps N = 145 patients Adjusted OR (95% CI) p (adjusted) Characteristics Size. *Median (IQR) *Mean (SD) Histology *Serrated, n (%) *Adenomatous, n (%) 25 (20,31) 28.5 (12.9) 92 (86.8) 246 (63.4) 35 (25.5). 38.4 (16.6) 14 (13.2) 142 (36.6) 0.95 (0.93 – 0.97) (per mm increase) 1.00 0.37 (0.19 – 0.73) < 0.001 0.04 Access difficulty *Easy or moderate n (%) *Severe, n (%) 323 (70.7) 15 (40.5) 134 (29.3) 22 (59.5) 1.00 0.26 (0.11 – 0.58) 0.001 Mucosal-Lifting *Complete, n (%) *Incomplete, n (%) 290 (73.8) 45 (46.4) 103 (26.2) 52 (53.6) 1.00 0.45 (0.26 – 0.78) 0.05 Piecemeal resection *No, n (%) *Yes, n (%) 46 (95.8) 292 (65.5) 2 (4.2) 154 (34.5) 1.00 0.13 (0.03 – 0.61) 0.010 Conclusions: In this multicenter study incomplete closure of the mucosal defect after EMR of large colorectal polyps was associated with polyp and procedure characteristics that reflect more difficult resections. Expertise in clipping of such lesions and investigation in improving clipping technique is needed to maximize clip closure and minimize bleeding risk of EMR.
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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 | 0.001 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".