Post–transanal endoscopic microsurgery (TEM) syndrome: a constellation of symptoms resulting from localized inflammatory changes after TEM
Bibliographic record
Abstract
Background: Transanal endoscopic microsurgery (TEM) is a safe and effective therapy for local excision of rectal lesions, but early postoperative infectious and inflammatory complications are variably defined in the literature. The aim of this study was to describe post-TEM syndrome, a cluster of postoperative symptoms related to a local inflammatory process seen in a subset of patients after TEM. Methods: We conducted a retrospective cohort study using prospectively collected observational data of all patients who underwent TEM at St. Paul’s Hospital in Vancouver, British Columbia, between 2006 and 2017. Results: During the study period, 795 patients were treated by TEM at the study institution. Of these, 56 patients had postoperative pain or fever and 26 patients were determined to have post-TEM syndrome based on our definition. Sixteen patients presented within the first 2 postoperative days, with all patients presenting within 1 week. All patients who underwent cross-sectional imaging (n = 11) had a combination of inflammatory changes with stranding and free fluid, or with small bubbles of free intraperitoneal, retroperitoneal, or mesorectal air, or with both; they did not have signs of free perforation or abscess at the surgical site. Nearly all patients with post-TEM syndrome (96%) did not progress to further infectious complications. Most patients’ (92%) post-TEM symptoms resolved within 1 week of conservative treatment. Conclusion: We provided a description of post-TEM syndrome, the constellation of symptoms arising from a localized inflammatory response in a subset of patients after TEM. This syndrome is uncommon, and nearly all patients recovered with conservative management without a need for more invasive intervention.
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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 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".