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Association between the ulcer status and the risk of delayed bleeding after the endoscopic mucosal resection of colon
Author(s) -
Kim GwangUn,
Seo Myeongsook,
Song Eun Mi,
Hwang Sung Wook,
Park Sang Hyoung,
Yang DongHoon,
Byeon JeongSik
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13804
Subject(s) - medicine , endoscopic mucosal resection , odds ratio , confidence interval , colonoscopy , argon plasma coagulation , surgery , gastroenterology , medical record , endoscopy , colorectal cancer , cancer
Background and Aim Bleeding is the most common adverse event following colonoscopic endoscopic mucosal resection (EMR). We aimed to assess the clinical outcomes of a colon EMR according to the post‐EMR ulcer status and determine the risk factors of delayed postpolypectomy bleeding (DPPB) based on the post‐EMR ulcer status. Methods The medical records and endoscopic images of patients who underwent EMR of colon polyps with diameters of ≥ 5 mm were retrospectively reviewed by us. If any exposed vessels were observed on the post‐EMR ulcer, the types of exposed vessels were classified into cut and uncut vessels. The coagulation injuries on the post‐EMR ulcer were categorized as grades 1, 2, or 3. Results In total, 505 patients with 728 polyps were examined. Exposed vessels were present in 416 post‐EMR ulcers, including cut vessels in 11 (1.5%) and uncut vessels in 405 (55.6%). With regard to coagulation injury, 113 (15.5%), 443 (60.9%), and 172 (23.6%) post‐EMR ulcers had grades 1, 2, and 3 injuries, respectively. DPPB was observed in 20 lesions (2.7%). Multivariate analysis indicated that a polyp size > 10 mm (odds ratio [OR], 3.354; 95% confidence interval [CI], 1.229–9.154), cut vessels (OR, 18.913; 95% CI, 3.106–115.187), and grade 3 coagulation injury (OR, 16.796; 95% CI, 1.825–154.556) were associated with DPPB. Conclusions Cut vessels and severe coagulation injury on post‐EMR ulcers, as well as larger polyp size, are risk factors for DPPB. Careful inspection of post‐EMR ulcers and prophylactic hemostasis, if necessary, may improve the clinical outcomes of colonoscopic EMR.