Combining endoscopic mucosal resection with hybrid argon plasma coagulation to reduce local colorectal lesion recurrence: a video tutorial
Bibliographic record
Abstract
Endoscopic mucosal resection (EMR) is a safe, effective, and surgery-sparing technique for removing large colorectal lesions [ 1 ]. Although piecemeal EMR is recommended for polyps > 20 mm in size, it remains a suboptimal technique for complete lesion resection, with high rates of residual polyp and recurrence rates reaching 15 % [ 2 ]. Hybrid argon plasma coagulation (hAPC) is a novel approach allowing ablation of resection margins and surface after EMR. hAPC combines waterjet injection and argon plasma coagulation (APC) in a single device. On-demand, repeatable saline cushioning without instrument exchange reduces thermal ablative insult to deep tissue structures, allowing for effective destruction of micro-remnants with reduced risk of perforation. High technical success and low recurrence rates (0 %) were shown in a pilot study using EMR in combination with hAPC [ 3 ]. A prospective international multicenter study showed that the local recurrence rate was only 2.2 % when using hAPC after EMR [ 4 ]. One recent meta-analysis found the local recurrence rate to be 3.3 % after hot EMR and margin ablation at 12-month follow-up [ 5 ]. We present a step-by-step video tutorial demonstrating how hAPC-assisted EMR is performed while providing technical tips to achieve optimal ablation results ([ Video 1 ]). Video 1 Video tutorial demonstrating how to perform hybrid argon plasma coagulation-assisted endoscopic mucosal resection in different clinical examples. Quality: mobile 360 480 720 Download hAPC-assisted EMR is done after standard initial assessment of polyp morphology and submucosal invasion. The polyp is removed in piecemeal fashion using a combination of an electrosurgical snare, cold snare, and forceps avulsion techniques ([ Fig. 1 ]). Following complete resection of the entire visible polyp, the base and margins of the submucosal defect are then lifted using the waterjet function of the hAPC probe and thermal ablation is performed. EMR margin ablation is performed with combinations alternating between 25–40 W pulsed-APC and precise-APC Effect 8–10 (11–21 W), with both modes using a flow of 0.8 L/min. Vessels can be prophylactically ablated; however, the clinical benefit of this is unclear at present. Fig. 1 The hybrid argon plasma coagulation (hAPC)-assisted endoscopic mucosal resection (EMR) technique for removal of colon polyps. a EMR is performed. b The resection area post-EMR. c Needless waterjet injection for margin and base lifting prior to hAPC. d Thermal ablation using hAPC. Endoscopy_UCTN_Code_TTT_1AQ_2AD Endoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply (currently EUR 375), discounts and wavers acc. to HINARI are available. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos Publication History Article published online: 18 November 2022 © 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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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 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.024 | 0.005 |
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".