Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?
Bibliographic record
Abstract
Significance of this studyWhat is already known about this subject?► Cold snare polypectomy (CSP) is considered to be a safer procedure than conventional hot snare polypectomy (HSP).► CSP is recommended by the European Society of Gastrointestinal Endoscopy guideline as the preferred technique for removal of diminutive colorectal polyp sized ≤5 mm.► However, it is not known if CSP is as effective as HSP to eradicate subcentimetre colorectal polyps.What are the new findings?► The complete resection rate for CSP for adenomatous polyps 4-9 mm in size was comparable to that of HSP. How might it impact on clinical practice in the foreseeable future?► CSP can be adopted as one of the standard techniques for the resection of 4-9 mm colorectal polyps. ABSTRACT ObjectiveTo investigate the success rate of cold snare polypectomy (CSP) for complete resection of 4-9 mm colorectal adenomatous polyps compared with that of hot snare polypectomy (HSP).Design A prospective, multicentre, randomised controlled, parallel, non-inferiority trial conducted in 12 Japanese endoscopy units.Endoscopically diagnosed sessile adenomatous polyps, 4-9 mm in size, were randomly assigned to the CSP or HSP group.After complete removal of the polyp using the allocated technique, biopsy specimens from the resection margin after polypectomy were obtained.The primary endpoint was the complete resection rate, defined as no evidence of adenomatous tissue in the biopsied specimens, among all pathologically confirmed adenomatous polyps.Results A total of 796 eligible polyps were detected in 538 of 912 patients screened for eligibility between September 2015 and August 2016.The complete resection rate for CSP was 98.2% compared with 97.4% for HSP.The non-inferiority of CSP for complete resection compared with HSP was confirmed by the +0.8% (90% CI -1.0 to 2.7) complete resection rate (non-inferiority p<0.0001).Postoperative bleeding requiring endoscopic haemostasis occurred only in the HSP group (0.5%, 2 of 402 polyps). ConclusionsThe complete resection rate for CSP is not inferior to that for HSP.CSP can be one of the standard techniques for 4-9 mm colorectal polyps.(Study registration: UMIN000018328)
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| 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".