A35 ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) OUTCOMES IN GASTROINTESTINAL SUBMUCOSAL TUMORS (SMT): A RETROSPECTIVE STUDY
Bibliographic record
Abstract
Abstract Background Gastrointestinal submucosal tumors (SMTs) range from benign entities to malignant tumors that require surveillence or resection. The role of ESD in management of SMTs remains unclear. Aims We aim to evaluate the clinical and technical outcomes of ESD in the management of SMTs. Methods This study included patients with SMTs who underwent ESD at the Kingston Health Sciences Center (KHSC) between May 2017 to September 2024. Data was collected on patient demographics and tumor characteristics including size, pathology, differentiation, depth, and lymphovascular invasion (LVI). Technical outcomes were analyzed with respect to procedure time (min), technical efficiency (min/cm2), en-bloc and R0 resection rates. En-bloc resection was defined as resection of the lesion piecemeal and R0 indicated negative margins on microscopic examination. We also reported clinical outcomes including length of stay, perioperative adverse events (e.g. bleeding or perforation), strictures, and tumor recurrence rates at the time of follow-up. Descriptive analysis was used to summarize the data. Results This case series included 22 patients (7 males, 15 females) with SMTs (6 esophageal, 16 gastric). 40.1% of patients (9/22) had endoscopic biopsy prior to ESD. The median specimen area was 3.8 cm2 (min-max range 0.38-18.2 cm2). Procedure times ranged between 5-138 mins with a mean time of 49.6 mins (SD= 33.1 mins) and mean efficiency of 13.7 min/cm2. 100% of patients had en-bloc resections and 86.3% (19/22) had R0 resections. There were no perioperative adverse events and most patients (21/22) were discharged the same day with the exception of one patient who stayed for 6 days postoperatively for (chronic) pain management. The pathology of the six esophageal tumors showed 3 leiomyomas, 2 Granular Cell Tumors (GCT), and 1 lipoma. Of the sixteen gastric lesions, 6 were Gastrointestinal Stromal Tumors (GIST), 6 were neuroendocrine tumors (NET), 1 leiomyoma, 1 lipoma, 1 inflammatory fibroid polyp, and 1 heterotopic pancreatic tissue. In both GIST and NET tumors, 5/6 lesions were Grade 1 (well-differentiated) and 1/6 was Grade 2 (moderately differentiated). The depth of the lesions was into the submucosa and there was no lymphovascular invasion (LVI). With regards to the esophageal tumors that required endoscopic follow-up (n= 4), the mean follow-up time was 8.5 months and there was no tumor recurrence. Of the gastric lesions that required endoscopic follow-up (n= 14), the mean follow-up time was 26.2 months and there was no tumor recurrence. There were no strictures observed on endoscopic follow-up for any of the lesions. Conclusions ESD for SMTs is a safe procedure with high en-bloc and R0 resection rates, along with low recurrence rates on follow-up. Larger scale studies are needed to further explore the efficacy and safety of ESD in the management of SMTs. 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 | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".