A RISK SCORING MODEL FOR THE PREDICTION OF DELAYED BLEEDING AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

JS Byeon; EM Song; M Seo; JW Cho; YJ Lee; BI Lee; JS Kim; SW Jeon; HJ Jang; DH Yang; BD Ye

doi:10.1055/s-0039-1681689

Endoscopy, Table of Contents

Endoscopy 2019; 51(04): S175-S176
DOI: 10.1055/s-0039-1681689

ESGE Days 2019 ePoster podium presentations

Saturday, April 6, 2019 13:00 – 13:30: Colon ESD 1 ePoster Podium 1

Georg Thieme Verlag KG Stuttgart · New York

A RISK SCORING MODEL FOR THE PREDICTION OF DELAYED BLEEDING AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Authors

JS Byeon

¹Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of
EM Song

²Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of
M Seo

³Konkuk University Chungju Hospital, Chungju, Korea, Republic of
JW Cho

⁴Presbyterian Medical Center, Jeonju, Korea, Republic of
YJ Lee

⁴Presbyterian Medical Center, Jeonju, Korea, Republic of
BI Lee

⁵Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of
JS Kim

⁶Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of
SW Jeon

⁷Kyungpook National University Chilgok Hospital, Daegu, Korea, Republic of
HJ Jang

⁸Hallym University School of Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea, Republic of
DH Yang

²Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of
BD Ye

²Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of

Abstract

Full Text

Aims:

Delayed bleeding is an important adverse event after colorectal endoscopic submucosal dissection (ESD). We aimed to investigate the incidence and risk factors of delayed bleeding after colorectal ESD, and to develop a risk scoring model for predicting delayed bleeding.

Methods:

This retrospective multicenter study was performed at 5 centers. The derivation and validation cohorts comprised 1189 patients from 1 center and 415 patients from the other 4 centers. We investigated the incidence and risk factors of delayed bleeding. Then, we developed a risk scoring model for predicting delayed bleeding using the data of the derivation cohort. We validated the scoring system in the validation cohort.

Results:

Delayed bleeding occurred in 34 (2.9%) patients in the derivation cohort. In multivariate analysis, the risk factors of delayed bleeding were tumor location in the rectosigmoid colon (odds ratio [OR] 6.49, 95% confidence interval [CI] 1.96 – 21.42; P = 0.002), large tumor (≥30 mm; OR 2.10, 95% CI 1.01 – 4.40; P = 0.048), and use of antiplatelet agents except for aspirin alone (OR 4.04, 95% CI 1.44 – 11.30; P = 0.008). These 3 factors were incorporated into a risk scoring model for prediction of delayed bleeding as the points of 2, 1, and 1, respectively. The area under the ROC curve for the risk score in the derivation cohort was 0.726 (95% CI 0.645 – 0.808), implying good discrimination ability. As the total score based on this system increased, the incidence of delayed bleeding increased in the validation cohort. When patients in the validation cohort were categorized into low- and high-risk groups, the incidence of delayed bleeding after colorectal ESD was higher in the high-risk group than in the low-risk group (4.2% vs. 1.9%).

Conclusions:

The risk scoring model incorporating tumor location, tumor size, and use of antiplatelet agents can quantitatively predict the risk of delayed bleeding after colorectal ESD.