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Background: Endoscopic mucosal resection of large non-pedunculated colon polyps is challenging. Objective: To determine if the time of day or daily endoscopic workload play a role in outcomes of endoscopic mucosal resection for large non-pedunculated colon polyps greater than 20 mm. Methods: This is a retrospective study of patients who underwent endoscopic mucosal resection of large non-pedunculated colon polyps. The time of day and endoscopic workload were compared across the following outcomes: the rate of complete resection of the polyp, the rate of referral for surgery, and the rate of residual neoplasia on follow-up. Results: One hundred and three endoscopic mucosal resection procedures were performed. There were no differences in the rates of complete resection (80.8% vs. 70.0%; P ¼ 0.25), the need for surgery (27.4% vs. 33.3%; P ¼ 0.55), and rate of residual neoplasia (24.5% vs. 50.0%; P ¼ 0.07) when comparing the time of day. Colon polyps greater than 40 mm were less likely to be completely resected versus polyps sized 20-39 mm (56.8% vs. 91.9%; P < 0.001). In cases with no residual neoplasia on follow-up, the mean duration for the index procedure was 45.6 minutes versus 60.7 minutes when there was residual neoplasia (P < 0.01). Conclusion: The time of day and endoscopic workload does not affect outcomes for endoscopic mucosal resection of large non-pedunculated colon polyps, but the size of large non-pedunculated colon polyps and resection times do.

Methods: We employed a multi-institutional database (Explorys Inc., Cleveland, OH); an aggregate of electronic health record data from 26 major US health systems. We formed cohorts of patients with CD and MC using Systemized Nomenclature of Medicine -Clinical Terms (SNOMED -CT). Microscopic colitis was defined as SNOMED terms "microscopic colitis" or "collagenous colitis." Univariate and multivariate analyses were performed on the data, and associations were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using IBM SPSS Statistics version 28. Results: Of 47,900,300 adult patients in the database, 143,290 (0.30%) carried a celiac disease diagnosis. Among CD patients, 70 (0.05%) carried a microscopic colitis diagnosis compared to 143,220 (99.95%) of the non-CD patients (p , 0.0001). After multivariate analysis, celiac disease was associated with an increased odds of microscopic colitis (aOR 5 10.5; 95% CI 8.59-12.94; p 5 , 0.0001) (Table ). Conclusion: This large population-based cohort study demonstrated significantly higher odds of MC among patients with celiac disease compared to patients without the disease with higher odds in females, older individuals, smokers, use of NSAIDs and PPIs. Our findings are in line with those from previous observational studies showing the same. Larger prospective studies would be beneficial in identifying the role of gluten exposure in development of microscopic colitis in patients with celiac disease.

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