A108 A RETROSPECTIVE REVIEW OF COMPLEX POLYP MANAGEMENT IN THE CHAMPLAIN REGION, ONTARIO
Bibliographic record
Abstract
Abstract Background Advanced endoscopic techniques have enabled the removal of polyps which, due to their size, location, or morphology, would otherwise have been removed surgically. Patients with such complex polyps should be referred promptly to expert centres for adjudication and management. Aims To review patterns of referral and initial management of complex polyps at The Ottawa Hospital (TOH), to identify gaps in care and to identify strategies to address those gaps. Methods We performed a retrospective chart review of cases where large (>3cm) colonic polyps were evaluated at TOH, from March 2019-March 2021. Cases were identified using Canadian Institute of Health Information codes. Descriptive statistics were analyzed, and were compared using Mann-Whitney U tests where appropriate. Results 94 consecutive patients with large polyps (mean age 68; 56.4% male) were included. The average polyp size was 4.7(4.4–5.1)cm. 45 patients were referred for a known complex polyp while the rest were referred for FIT/FOBT+ (n=20), symptoms or anemia (n=17), surveillance (n=9), or abnormal imaging (n=3). 32 patients were referred from >50km from Ottawa (travelling), and 62 were referred from <50km from Ottawa (local). Of the 45 referrals for known polyp, 20 (44.4%) included photodocumentation of the lesion; 33 (73.3%) had a prior biopsy, and 8 (17.8%) were partially removed. Key statistics are summarized in Table 1. All 8 patients referred with a partially removed polyp eventually had a successful endoscopic polypectomy. 10/94 (10.6%) patients required surgical resection: 7 for malignant pathology, and 3 for endoscopic failure. Overall, 3 patients had post-polypectomy bleeding, and 1 patient sustained a full-thickness perforation. As of October 2021, 26/78 (33.3%) patients eligible for a 4–6 month recheck and 36/48 (75%) patients eligible for a 12-month follow-up colonoscopy were overdue. Conclusions This retrospective review highlights significant differences in the management of complex polyps based on patient geography and the need to develop strategies to improve access for patients referred from outside of Ottawa. As expected, COVID had a significant impact on the time to complete removal of polyps, and affected the timely endoscopic follow up of these high-risk patients. Strategies to ensure timely endoscopic follow up of patients after complex polyp removal are needed. Funding Agencies None
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.007 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".