Evolution of re-epithelialization postcircumferential esophageal endoscopic submucosal dissection
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Bibliographic record
Abstract
https://www.videogie.org/cms/asset/351c6687-280a-4c5b-97ab-c96ae280c04b/mmc1.mp4Loading ... Download .mp4 (93 MB) Help with .mp4 files Video 1This patient with Barrett’s esophagus with multifocal high-grade dysplasia underwent complete circumferential ESD. We illustrate the evolution of re-epithelialization after circumferential esophageal ESD and the regimen used to prevent stricture formation. https://www.videogie.org/cms/asset/351c6687-280a-4c5b-97ab-c96ae280c04b/mmc1.mp4Loading ... Download .mp4 (93 MB) Help with .mp4 files Video 1This patient with Barrett’s esophagus with multifocal high-grade dysplasia underwent complete circumferential ESD. We illustrate the evolution of re-epithelialization after circumferential esophageal ESD and the regimen used to prevent stricture formation. A 62-year-old woman with C1M5 Barrett's with multifocal high-grade dysplasia on biopsy was referred for management. Various treatment options were reviewed, including endoscopic mucosal resection, radiofrequency ablation, staged endoscopic submucosal dissection (ESD), and complete circumferential ESD. The decision was made to proceed with complete circumferential ESD.The complete circumferential ESD was completed in 2.5 hours without any adverse events. The distal and proximal margins were normal gastric and normal squamous mucosa, respectively.The patient was discharged 24 hours later, consuming a full fluid diet that was gradually advanced over 4 days to a normal diet. After the procedure, the patient was initiated on the following regimen:1.Prednisone 30 mg daily for 4 weeks, then tapered by 5 mg every 2 weeks2.Sucralfate suspension 1g 4 times daily3.Budesonide 1 mg 4 times daily mixed with the sucralfate4.Rabeprazole 20 mg twice dailyFigure 1 illustrates the evolution of re-epithelialization from day 0 to 32 weeks after circumferential ESD.Complete circumferential ESD achieved R0 resection of both the dysplastic Barrett's and the entire segment of Barrett’s simultaneously. This case demonstrates the evolution of re-epithelialization after circumferential ESD. Furthermore, stricture prophylaxis was achieved with the use of prednisone, topical budesonide, sucralfate suspension, proton pump inhibitors, and 2 prophylactic balloon dilations (Video 1, available online at www.VideoGIE.org).DisclosureDr Bechara is a consultant for Olympus and Medtronic. A 62-year-old woman with C1M5 Barrett's with multifocal high-grade dysplasia on biopsy was referred for management. Various treatment options were reviewed, including endoscopic mucosal resection, radiofrequency ablation, staged endoscopic submucosal dissection (ESD), and complete circumferential ESD. The decision was made to proceed with complete circumferential ESD. The complete circumferential ESD was completed in 2.5 hours without any adverse events. The distal and proximal margins were normal gastric and normal squamous mucosa, respectively. The patient was discharged 24 hours later, consuming a full fluid diet that was gradually advanced over 4 days to a normal diet. After the procedure, the patient was initiated on the following regimen:1.Prednisone 30 mg daily for 4 weeks, then tapered by 5 mg every 2 weeks2.Sucralfate suspension 1g 4 times daily3.Budesonide 1 mg 4 times daily mixed with the sucralfate4.Rabeprazole 20 mg twice daily Figure 1 illustrates the evolution of re-epithelialization from day 0 to 32 weeks after circumferential ESD. Complete circumferential ESD achieved R0 resection of both the dysplastic Barrett's and the entire segment of Barrett’s simultaneously. This case demonstrates the evolution of re-epithelialization after circumferential ESD. Furthermore, stricture prophylaxis was achieved with the use of prednisone, topical budesonide, sucralfate suspension, proton pump inhibitors, and 2 prophylactic balloon dilations (Video 1, available online at www.VideoGIE.org). DisclosureDr Bechara is a consultant for Olympus and Medtronic. Dr Bechara is a consultant for Olympus and Medtronic. Supplementary datahttps://www.videogie.org/cms/asset/351c6687-280a-4c5b-97ab-c96ae280c04b/mmc1.mp4Loading ... Download .mp4 (93 MB) Help with .mp4 files Video 1This patient with Barrett’s esophagus with multifocal high-grade dysplasia underwent complete circumferential ESD. We illustrate the evolution of re-epithelialization after circumferential esophageal ESD and the regimen used to prevent stricture formation. https://www.videogie.org/cms/asset/351c6687-280a-4c5b-97ab-c96ae280c04b/mmc1.mp4Loading ... Download .mp4 (93 MB) Help with .mp4 files Video 1This patient with Barrett’s esophagus with multifocal high-grade dysplasia underwent complete circumferential ESD. We illustrate the evolution of re-epithelialization after circumferential esophageal ESD and the regimen used to prevent stricture formation.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| 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 it