S597 Endoscopic Mucosal Resection versus Partial Colectomy for Benign Colorectal Polyps in a Propensity-Matched Cohort
Bibliographic record
Abstract
Introduction: Despite advances in endoscopic mucosal resection (EMR), the rates of surgical resection for benign colorectal polyps continue to rise. Population studies have shown high cost, morbidity, and mortality associated with surgery, but data directly comparing surgical outcomes with EMR are scarce. The aim of this study was to compare outcomes of EMR and surgical resection, including the need for short or long-term re-intervention, for benign colorectal polyps between two propensity-matched cohorts. Methods: Using a large, electronic health record-derived national dataset (TriNetX), cohorts that underwent EMR and partial colectomy for benign colorectal polyps from 2010-2020 were identified. Propensity score matching (1:1) was performed based on age, sex, race, ethnicity, body mass index (BMI), carcinoembryonic antigen (CEA) level, inflammatory bowel disease, family history of colorectal cancer (CRC), and polyp location based on ICD-10 coding. Univariate analyses were performed on cohort-level data. Outcomes were assessed at 30 days post-procedure and included re-intervention (surgery, percutaneous drain, or endoscopy), emergency department visit, critical care admission, and all-cause mortality. New diagnoses of CRC after initial intervention were assessed at up to 10 years of follow-up. Results: The EMR and surgery cohorts contained 16,639 and 5,847 patients, respectively. After matching, two cohorts of 4,410 remained (Table 1). At 30 days, EMR was associated with lower rates of all outcomes assessed (Table 2). All-cause mortality was lower for EMR compared with surgery (0.23% vs 2.56%, odds ratio, OR, 0.09, 95% confidence interval, CI, 0.04-0.17). At 30 days, the surgery cohort had a 3.3% rate of re-operation, whereas the EMR cohort had a 1.5% rate of repeat colonoscopy. Only 0.9% of patients underwent surgical resection within 3 years of EMR. At 10 years, there was no difference in new-onset CRC between the cohorts (OR 0.98, 95% CI 0.41-2.37). Conclusion: EMR for benign colorectal polyps is associated with significantly lower morbidity and mortality compared with surgical resection. Moreover, there were no significant differences in the development of future CRC between the cohorts. Few patients require surgical resection following initial EMR of benign colorectal polyps. Studies able to analyze data on individual polyp characteristics would aid in further understanding the ongoing high rates of surgical referrals for benign colorectal polyps.Figure 1.: Propensity score matching resultsTable 1.: 30-day outcomes between the matched cohorts
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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 | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".