Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps

Timothy R. Elliott; Zacharias P. Tsiamoulos; Siwan Thomas-Gibson; Noriko Suzuki; Leonidas A. Bourikas; Ailsa Hart; Paul Bassett; Brian P. Saunders

doi:10.1055/a-0577-3206

Endoscopy, Table of Contents

Endoscopy 2018; 50(08): 790-799
DOI: 10.1055/a-0577-3206

Original article

Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps

Authors

Timothy R. Elliott^*

¹Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, United Kingdom

²The University of Melbourne, Melbourne, Victoria, Australia
Zacharias P. Tsiamoulos^*

¹Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, United Kingdom
Siwan Thomas-Gibson

¹Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, United Kingdom
Noriko Suzuki

¹Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, United Kingdom
Leonidas A. Bourikas

¹Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, United Kingdom

³Department of Gastroenterology, University of Crete, Greece
Ailsa Hart

⁴Inflammatory Bowel Disease Unit, St Mark’s Hospital and Academic Institute, London, United Kingdom
Paul Bassett

⁵Statsconsultancy LTD, Amersham, United Kingdom
Brian P. Saunders

¹Wolfson Unit for Endoscopy, St Mark’s Hospital and Academic Institute, London, United Kingdom

Abstract

Background Delayed bleeding is the most common significant complication after piecemeal endoscopic mucosal resection (p-EMR) of large nonpedunculated colorectal polyps (NPCPs). Risk factors for delayed bleeding are incompletely defined. We aimed to determine risk factors for delayed bleeding following p-EMR.

Methods Data were analyzed from a prospective tertiary center audit of patients with NPCPs ≥ 20 mm who underwent p-EMR between 2010 and 2012. Patient, polyp, and procedure-related data were collected. Four post p-EMR defect factors were evaluated for interobserver agreement and included in analysis. Delayed bleeding severity was reported in accordance with guidelines. Predictors of bleeding were identified.

Results Delayed bleeding requiring hospitalization occurred after 22 of 330 procedures (6.7 %). A total of 11 patients required blood transfusion; of these, 4 underwent urgent colonoscopy, 1 underwent radiological embolization, and 1 required surgery. Interobserver agreement for identification of the four post p-EMR defect factors was moderate (kappa range 0.52 – 0.57). Factors associated with delayed bleeding were visible muscle fibers (P = 0.03) and the presence of a “cherry red spot” (P = 0.05) in the post p-EMR defect. Factors not associated with delayed bleeding were American Association of Anesthesiologists class, aspirin use, polyp size, site, and use of argon plasma coagulation.

Conclusions Visible muscle fibers and the presence of a “cherry red spot” in the resection defect were associated with delayed bleeding after p-EMR. These findings suggest evaluation and photodocumentation of the post p-EMR defect is important and, when considered alongside other patient and procedural factors, may help to reduce the incidence and severity of delayed bleeding.

Full Text

References

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