Risk Factors for Intraprocedural and Clinically Significant Delayed Bleeding After Wide-field Endoscopic Mucosal Resection of Large Colonic Lesions

Background & Aims Wide-field endoscopic mucosal resection (WF-EMR) of large sessile colonic polyps is a safe and cost-effective outpatient treatment. Bleeding is the main complication. Few studies have examined risk factors for bleeding during the procedure (intraprocedural bleeding [IPB]) or af...

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Veröffentlicht in:Clinical gastroenterology and hepatology 2014-04, Vol.12 (4), p.651-661.e3
Hauptverfasser: Burgess, Nicholas G, Metz, Andrew J, Williams, Stephen J, Singh, Rajvinder, Tam, William, Hourigan, Luke F, Zanati, Simon A, Brown, Gregor J, Sonson, Rebecca, Bourke, Michael J
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Sprache:eng
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Zusammenfassung:Background & Aims Wide-field endoscopic mucosal resection (WF-EMR) of large sessile colonic polyps is a safe and cost-effective outpatient treatment. Bleeding is the main complication. Few studies have examined risk factors for bleeding during the procedure (intraprocedural bleeding [IPB]) or after it (clinically significant post-endoscopic bleeding [CSPEB]). We investigated factors associated with IPB and CSPEB in a large prospective study. Methods We analyzed data from WF-EMRs of sessile colorectal polyps ≥20 mm in size (mean size, 35.5 mm), which were performed on 1172 patients (mean age, 67.8 years) from June 2008–March 2013 at 7 tertiary hospitals as part of the Australian Colonic Endoscopic Resection Study. Data were collected on characteristics of patients and lesions, along with outcomes of procedures and clinical and histologic analyses. Independent predictors of IPB and CSPEB were identified by multiple logistic regression analysis. Results Of the patients studied, 133 (11.3%) had IPB. Independent predictors included increasing lesion size (odds ratio, 1.24/10 mm; P < .001), Paris endoscopic classification of 0–IIa + Is (odds ratio, 2.12; P = .004), tubulovillous or villous histology (odds ratio, 1.84; P  = .007), and study institutions that performed the procedure on fewer than 75 patients (odds ratio, 3.78; P  
ISSN:1542-3565
1542-7714
DOI:10.1016/j.cgh.2013.09.049