A36 SERRATED POLYPOSIS SYNDROME OUTCOMES IN THE COLD SNARE RESECTION ERA
Bibliographic record
Abstract
Abstract Background Surgery is indicated in patients with serrated polyposis syndrome [SPS] when the polyp burden is no longer manageable endoscopically. Evidence has emerged supporting the efficacy and safety of cold snare resection [CSR] for large sessile serrated lesions; however, the role of a primary cold snare resection algorithm [PCSRA] in patients with SPS is unknown Aims We aimed to evaluate the efficacy of a PCSRA in patients with SPS Methods Utilizing an established retrospective cohort (2013-2023), all patients with a diagnosis of SPS were evaluated, based on the 2019 World Health Organization [WHO] criteria. Patients were stratified by index colonoscopy into the pre-PCSRA (01/2013-12/2020) and the post-PCSRA (01/2021-08/2023). Outcomes included achieving clearance (complete removal of all serrated class lesions [SCL] at procedure completion), adverse events, and referral for surgery. Continuous and categorical variables were summarised using median (IQR) and frequencies respectively. Fisher Exact test was used to compare categorical variables. Results 178 patients with SPS were included in the analysis (N=144, 80.9% pre-PCSRA; N=34, 19.1% post-PCSRA). Median age at first colonoscopy was 62 years (IQR 9 years) and 115 (64.6%) were female. In the post-PCSRA, 593 SCLs were identified: 326 diminutive (< 5mm), 147 small (5-9mm), 66 medium (10-19mm), and 54 large (≥ 20mm). Among both SCLs and adenomatous lesions, 93.4% (N=627) were removed by CSR. Endoscopic clearance was achieved in 30 (88.2%) patients and 1 patient (2.9%) underwent surgery, which preceded referral for endoscopic management. In comparing the pre-PCSRA vs. the post-PCSRA: 110 (76.4%) achieved clearance in the pre-PCSRA group (P=0.09). No delayed bleeding was observed in the post-PCSRA group as opposed to 3 (2.2%) in pre-UCSRA (p = 0.50). Intra-procedural perforation was reported in 1 patient in the post-PCSRA vs. 2 in the pre-PCSRA group (p=0.47). Only 1 delayed perforation was reported in the pre-PCSRA group (p=0.81). Twenty-one (13.9%) patients underwent surgery: 20 in the pre-PCSRA (94.7%; 9 due to polyp burden and 11 for colorectal cancer) and 1 in the post-PCSRA (colorectal cancer) (p=0.08). Conclusions Cold snare resection should be considered as the first-line resection modality for most lesions identified in patients with SPS. 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 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".