Combined ESD-TAMIS approach for local excision of recurrent low rectal lesion: a case report
Bibliographic record
Abstract
Background: Timely management of dysplastic and early neoplastic colorectal lesions is essential in reducing the burden of colorectal cancer. With the advent of technology, en-bloc resection of large polyps can be accomplished via endoscopic submucosal dissection (ESD) or transanal minimally invasive surgery (TAMIS). The standard of care for rectal lesions not amenable to minimally invasive resection includes an abdominal peritoneal resection and a colostomy. We present a case of a patient with a large recurrent rectal lesion with significant scarring extending beyond the dentate line, where a novel combined ESD-TAMIS approach was utilized to successfully excise the lesion. Case Description: A 78-year-old female, with no first-degree family history of colorectal cancer, was referred for excision of a recurrent rectal polyp that has undergone multiple interventions with clear residual and recurrent adenomas. Prior attempts included snare-based polypectomy, piecemeal excisions and surgical transanal excisions. Sigmoidoscopy demonstrated a mixed laterally spreading tumor in the distal rectum, occupying 90% of the circumference of the lumen, involving dentate line and extending 7 cm proximally. The lesion was Paris IIa + Is, with surface mucosal pattern in keeping with Japanese NBI expert team (JNET) classification 2A + 2B suspicious for high-grade dysplasia. A combined ESD-TAMIS approach enables accurate identification of the lesion borders under high resolution endoscopy, access to the dentate line, and full thickness excision of areas with significant scarring. This combined approach was safe and effective in excising the lesion and the patient was able to avoid an abdominal peritoneal resection and a colostomy. Conclusions: We describe the combined use of ESD with TAMIS for the local excision of a large, recurrent lesion with extensive fibrosis extending to the dentate line that would otherwise require abdominoperineal resection with permanent colostomy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".