Risk factors for delayed bleeding after endoscopic submucosal dissection of colorectal tumors
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Risk factors for delayed bleeding after endoscopic submucosal dissection of colorectal tumors Ran Li1,2 · Shilun Cai1,2 · Di Sun1,2 · Qiang Shi1,2 · Zhong Ren1,2 · Zhipeng Qi1,2 · Bing Li1,2 · Liqing Yao1,2 · Meidong Xu1,2 · Pinghong Zhou1,2 · Yunshi Zhong1,2 Received: 28 April 2019 / Accepted: 6 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Aim To investigate the risk factors for delayed bleeding following endoscopic submucosal dissection (ESD) for colorectal neoplasms. Methods We retrospectively reviewed the medical records of 991 consecutive patients who underwent ESD for colorectal neoplasms at our hospital from January 2007 to November 2016. Delayed post-ESD bleeding was defined as bleeding within 6 h to 30 days after ESD that resulted in either of the three situations: overt hematochezia, bleeding spots confirmed by repeat colonoscopy, or the requirement of a blood transfusion. Delayed bleeding was furtherly separated into early and late delayed bleeding by the end of post-ESD day 2. We analyzed the relationship between delayed bleeding and candidate factors including patient-, lesion-, and treatment-related details. Results Delayed post-ESD bleeding was found in 47 patients (4.7%), of which 18 cases were late delayed bleeding. Among all patients, 14 patients required a second colonoscopy, and 2 other patients were transferred to surgery. Univariate analysis revealed that patients with hypertension (p = 0.017) and using hot biopsy forceps for wound management (p = 0.028) were significantly associated with late delayed bleeding. Both risk factors remained significant after multivariate analysis: hypertension (OR 2.829, 95% CI 1.101–7.265, p = 0.031), hot biopsy forceps (OR 2.873, 95% CI 1.013–8.147, p = 0.047). Using hot biopsy forceps was also the significant risk factor for late delayed bleeding compared with early delayed bleeding. Conclusion Patient with hypertension and using hot biopsy forceps for wound management during procedure call for attention on high risk of delayed post-ESD bleeding. Therefore, additional perioperative treatment is recommended in patients with these risk factors. Keywords Endoscopic submucosal dissection · Colorectal neoplasms · Delayed bleeding · Risk factors Endoscopic submucosal dissection (ESD) enables physicians to resect large tumors completely with pathologically evaluable details. Nowadays more and more patients with earlystage colorectal cancer are willing to receive endoscopic treatment because of its minimal invasive feature. Unlike endoscopic mucosal resection (EMR), ESD is often used for en bloc resection of flat or depressed Ran Li, Shilun Cai and Di Sun contribute equally to this paper. * Yunshi Zhong [email protected] 1
Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
Endoscopy Research Institute of Fudan University, 180 Fenglin Road, Shanghai 200032, China
2
colorectal tumors > 20 mm, which is a standard procedure recommended by the
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