Identifying the impossible: piecemeal cold snare resection perforation
Bibliographic record
Abstract
Background and Aim: Piecemeal cold snare resection (CSR) is an increasingly adopted technique for large nonpedunculated colorectal polyps because of its favorable safety profile. Although adverse events are rare, perforation after CSR has been reported infrequently. We present a video case of intraprocedural perforation during piecemeal CSR. Methods: A 63-year-old woman with quiescent colonic Crohn disease underwent dysplasia surveillance, revealing multiple flat polyps, including 2 adjacent large 0-IIA transverse colon polyps. Piecemeal CSR was performed using chromoinjectate and a 10-mm cold snare. Careful inspection of the resection base with submucosal chromoendoscopy revealed a type IV deep mural injury, despite the absence of electrocautery. The defect was closed using through-the-scope clips. The patient was observed and discharged with antibiotics, with no delayed adverse events at follow-up. Histopathology confirmed sessile serrated lesions without dysplasia. Conclusion: This case demonstrates that perforation, although rare, can occur during CSR. Endoscopists should perform meticulous resection base assessments, as the absence of cautery may obscure signs of deep mural injury.
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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 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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".