549 Efficacy and Safety of Non-Elevated Piecemeal Polypectomy Using Hot Snare
Bibliographic record
Abstract
INTRODUCTION: Piecemeal polypectomy refers to the removal of large sessile colonic polyps by means of multiple snarings and is commonly performed after submucosal injection of a liquid, typically normal saline. Some reports suggest submucosal injection may not be benign, due to concerns of needle tracking of neoplastic cells, and difficulty in removal of recurrences due to scarring after injection. There is a paucity of recent literature describing polypectomy without submucosal injection. Historically, non-elevated piecemeal polypectomy has been criticized for concerns regarding bleeding and perforation. The purpose of this study was to describe a retrospective review of colonic polyps removed using non-elevated piecemeal polypectomy and associated outcomes. METHODS: An outpatient endoscopy center database was searched for patients who had large (≥3.0) sessile polyps excised using non-elevated piecemeal polypectomy technique between December 2012 and December 2018. All polyps with invasive cancer were excluded (n = 3). Chart review was carried out to extract demographic data, outcomes and adverse events. Details of all subsequent colonoscopies, including recurrences, residual tissue, or need for surgery were recorded. RESULTS: During the study period, 73 patients underwent 78 non-elevated piecemeal polypectomies for polyps ≥3 cm. There were 27 (37%) female patients and 46 (63%) male patients. Most common polyp sizes were between 3.5 cm to 3.9 cm (48.7%) or ≥4 cm (52.6%). Tubulovillous adenoma was the most frequent histological subtype (48.7%). Most polypectomies occurred in the right colon (54.4%). There were zero events of perforation. Ten (12.6%) patients had intraprocedural bleeding controlled endoscopically. Four patients (5.1%) had post-procedural bleeding, 3 required colonoscopy and clip hemostasis. There were 10 recurrences (12.8%), nine were found at the first endoscopic follow up and controlled by means of non-elevated hot snare polypectomy. One patient had a persistent recurrence and required subsequent surgical management for an adenocarcinoma. CONCLUSION: Non-elevated piecemeal polypectomy with hot snare is a safe and effective technique for the removal of large sessile (≥3 cm) colonic polyps. Perforation and bleeding are uncommon. Recurrences are easily controlled by additional hot snare resection.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".