Comparing margin ablation techniques after endoscopic mucosal resection of large nonpedunculated colorectal polyps
Bibliographic record
Abstract
Aims This study compared local recurrence rate (LRR) after EMR without margin ablation, when using STSC margin, APC margin or hybrid APC (h-APC) margin and surface ablation. Methods A retrospective analysis was performed from several prospective collected EMR studies (NCT04220905, NCT04015765, NCT04117100). Data from 18–89-year-old patients undergoing hot snare EMR without ablation and with STSC margin ablation, APC margin ablation or h-APC margin and surface ablation were compared from 2017 to 2022. The included EMRs were taken from periods where margin ablation was historically not known to reduce recurrence as well as periods where margin ablation became routine practice. Patients with at least one follow-up colonoscopy with inspection of the post-EMR site for recurrence were included. The primary outcome was LRR at the first follow-up colonoscopy. Results A total of 411 patients (mean age: 65.1y, SD: 10.1, 46.4% female) with 441 EMRs were included. At surveillance colonoscopies recurrence rate was 22.6% (33/146, 95% Confidence Interval [CI]=16.1-30.3) in cases without ablation, 11.5% with STSC (16/139, 95%CI=6.7-18.0), 23.5% with APC (12/51, 95%CI=12.8-37.5), and 1.9% with h-APC ablation (2/105, 95%CI=0.2-6.7). Post-EMR LRR was significantly lower for h-APC compared to STSC (p=0.004), and significantly lower for STSC compared to no ablation (p=0.013). There was no significant difference for LRR between APC ablation and no margin ablation ([ Table 1 ]). Table 1 Conclusions EMR with h-APC margin and surface ablation resulted lower post-EMR recurrence rates compared to all other modalities. Both, h-APC and STSC significantly reduced LRR compared to no ablation. APC alone did not reduce LRR compared to no ablation. Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. 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 | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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 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".