A134 ENDOSCOPIC RESECTION IS EFFECTIVE FOR COMPLEX LARGE NON-PEDUNCULATED COLORECTAL POLYPS
Bibliographic record
Abstract
Abstract Background Endoscopic resection is preferred for most large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) due to superior efficacy, safety, and cost-efficiency compared to surgery. However, endoscopic resection can be challenging due to anatomical location, lesion characteristics, and concomitant colonic disease; these complex LNPCPs (C-LNPCPs) historically have suboptimal outcomes compared to uncomplicated LNPCPs (UC-LNPCPs). Aims To compare the outcomes of C-LNPCPs to UC-LNPCPs following endoscopic resection. Methods Consecutive patients ampersand:003E 18 years of age who underwent endoscopic resection of a LNPCP were enrolled in a prospective single center observation cohort study (clinicaltrials.gov ID: NCT05402696). C-LNPCP were defined by at least one of the following criteria: involvement of the appendiceal orifice, ileocecal valve, or anorectal junction; previous resection attempt; ≥ 90% circumferential involvement; concomitant inflammatory bowel disease. All other lesions were classified as UC-LNPCPs. Performance was evaluated by technical success (all neoplastic tissue removed at index procedure), procedure-related adverse events (intra-procedural perforation, clinically significant post-endoscopic resection bleeding (CSPEB), delayed perforation, serositis), referral to surgery, and recurrence at first surveillance colonoscopy (SC1). Results From 06/2022-09/2023, 350 LNPCPs were referred for endoscopic resection and 335 were attempted (91 C-LNPCPs, 244 UC-LNPCPs). Median age was 68 years (IQR 62-74 years) and 144 (54.1%) were male. Median size was 30mm (IQR 20-40mm). Most lesions were adenomatous (63.7% C-LNPCPs, 64.8% UC-LNPCPs), with cancer identified in 3.3% and 4.9% of C-LNPCPs and UC-LNPCPs, respectively. EMR was the most common resection modality (62.6% C-LNPCPs vs. 64.8% UC-LNPCPs) with C-LNPCPs undergoing more ESD (17.6% vs. 7.0%) and less CSR (19.8% vs. 28.3%; p=0.011). Auxiliary modalities were more frequently used in C-LNPCPs (6.6% vs. 1.2% UC-LNPCPs; p=0.004). Technical success was 95.6% in C-LNPCPs compared to 99.2% in UC-LNPCPs (p=0.049). There was no significant difference between groups in the frequencies of adverse events. 17 LNPCPs (5.1%; 4 C-LNPCP, 13 UC-LNPCPs) underwent surgery (p=1.000). Of those LNPCPs assessed at SC1, there was 1 recurrence (1.0%) in the UC-LNPCP subgroup. Conclusions With site-specific technical modifications and mitigating strategies for procedural-related adverse events, endoscopic resection outcomes for C-LNPCPs are comparable to UC-LNPCPs. Funding Agencies None
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| 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 | 0.000 |
| 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".