A209 ESOPHAGEAL EPIDERMOID METAPLASIA: ADVOCATING FOR A PRIMARY ENDOSCOPIC SUBMUCOSAL DISSECTION APPROACH
Bibliographic record
Abstract
Abstract Background Esophageal epidermoid metaplasia (EM), or leukoplakia, is a rare finding on endoscopy; typically seen incidentally as a white plaque and histologically characterized by orthokeratosis. The link between EM and squamous neoplasia has been identified. There is no consensus on the management of EM. Aims To present a case of circumferential esophageal EM managed with endoscopic submucosal dissection (ESD). Methods Case report and review of the literature Results A 56-year-old female with a known history of EM was referred for consideration of ESD due to dysplastic progression confirmed on histopathology. Previous attempts at eradication included argon plasma coagulation and staged band mucosectomy. Fully circumferential ESD was performed over a 100mm segment in the mid esophagus using the double tunnel technique. Histopathology revealed multifocal low-grade squamous intraepithelial neoplasia within epidermoid metaplasia with negative margins. Conclusions Esophageal epidermoid metaplasia may increase the risk of squamous cell carcinoma. There are no consensus recommendations regarding its management with previous described strategies including surveillance and eradication with radiofrequency ablation and band mucosectomy. ESD for epidermoid metaplasia has not been described; however, given the overall efficacy, efficiency, safety and now widespread availability of this technique a primary ESD approach should be considered. 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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
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".