Is it time to consider prophylactic appendectomy in patients with serrated polyposis syndrome undergoing surveillance?
Bibliographic record
Abstract
Universal colorectal cancer (CRC) screening and minimally invasive endoscopic resection techniques are transforming serrated polyposis syndrome (SPS) management. However, serrated lesions of the appendix (SLAs) are an emerging concern. The prevalence and clinical ramifications of SLAs are likely understated due to the historical role of surgery. Covert intra-appendiceal lesions are surprisingly common but cannot be detected endoscopically nor surveyed. Of those with extension into the caecum, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR) all have intrinsic limitations in this location. Herein we discuss the potential role for prophylactic appendectomy in patients with SPS. Although SPS is now in the purview of the endoscopist, SLAs remain a challenge from two perspectives: (1) covert lesions which cannot be detected nor surveyed; (2) endoscopic management limitations in this location. As a true diverticulum, the appendix shares the histological layers of the colon with an average length and diameter of 8 cm and 8 mm, respectively. Assuming a cylindrical shape, it reflects 7% of the surface area of the right colon (online supplementary figure 1).1–3 However, due to its narrow calibre the appendiceal lumen cannot be evaluated. Thus, the patient remains at risk for covert disease progression and ultimately interval CRC. In a retrospective analysis of 34 patients with SPS who underwent surgery, SLAs were identified incidentally in 68%, with 26% having advanced histopathology.4 ### Supplementary data [gutjnl-2020-321445supp001.pdf] The relevance of these findings has been understated in existing SPS cohorts. Until recently, universal CRC screening has not been the international standard. Consequently, many patients with SPS are not detected by screening but present with CRC or CRC is detected at the time of …
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 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".