Risk stratification for stricture formation after endoscopic submucosal dissection for esophageal dysplasia
Bibliographic record
Abstract
We aimed to evaluate the demographic, clinical, procedural, and histopathologic factors associated with stricture development following esophageal endoscopic submucosal dissection (ESD). We conducted a retrospective cohort study of patients undergoing ESD for esophageal lesions from 2019 to 2024 at St. Michael's Hospital, in Toronto, Canada. The primary outcome was stricture formation, defined as a symptomatic luminal narrowing at the ESD site confirmed on follow-up endoscopy, requiring intervention. Strictures requiring dilation developed in 24% of patients, 85% of which were impassable with a standard gastroscope (9.9 mm diameter). Stricture rates increased with defect circumferential involvement: <50% (7.7%), 50%-74% (11.5%), 75%-89% (23.1%), and ≥90% (57.7%). Intraprocedural local triamcinolone acetate (LTA) injection was administered in 40 of 108 patients (37%), with a mean defect circumferential size of 87.5%. Among patients receiving LTA, stricture rates varied based on defect size: for <50% circumferential defect involvement (n = 1) and 50%-74% (n = 3), no strictures developed; for 75%-90% (n = 17), 6 patients (35%) developed strictures, 5 of which were impassable; and for 90%-100% (n = 19), 11 patients (58%) developed strictures, all of which were impassable. Patients selectively discharged on prophylactic steroids demonstrated varied stricture rates depending on the steroid regimen: prednisone (61.5%), oral budesonide (26.9%), and combination therapy (7.7%). Independent predictors of stricture formation included defect circumferential involvement (OR 1.07, 95% CI 1.03-1.12, p < 0.001), length of hospitalization (OR 1.88, 95% CI 1.11-3.16, p = 0.018), and presence of deep mural injury (OR 6.28, 95% CI 1.10-35.88, p = 0.039). Stricture formation post-ESD is strongly associated with lesion and procedural characteristics, including defect circumferential involvement, deep mural injury, and length of hospitalization.
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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 | 0.002 |
| 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 | 0.000 |
| 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".